Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review

Systematic review of adherence to swallow and trismus exercises during radiation therapy for head and neck cancer

Understanding the barriers and facilitators for prophylactic swallowing and trismus exercises for patients undergoing radiation to the head and neck may help exercise adherence. The analysis reviews all published reports of exercise adherence with a critical appraisal following PRISMA guidelines. A total of 137 potential papers were identified; 20 studies met the inclusion criteria. The most commonly reported facilitators for swallowing and trismus exercises were regular clinician contact and online resources to reinforce instructions, set goals, and manage radiation toxicities. Social support and perceived benefit from exercises were also reported to be of help. The most common barriers to exercise were radiation toxicities, anxiety, feeling overwhelmed with information, and not understanding the reason for the exercises. Understanding facilitators and barriers to adherence is critical when designing exercise interventions for patients undergoing radiation for head and neck cancer.

Use of smartphones and tablets after acquired brain injury to support cognition

OBJECTIVES

To describe the use of mobile devices after acquired brain injury (ABI), from the perspectives of injured individuals and significant others, and to examine factors associated with mobile device use for cognition.

METHODS

Cross-sectional study with 50 adults with moderate/severe traumatic brain injury or stroke (42% women; mean of 50.7 years old, 4.6 years post-ABI), and 24 significant others. Participants completed questionnaires on mobile technology, cognitive functioning and the impact of technology.

RESULTS

Of 45/50 adults with ABI who owned a smartphone/tablet, 31% reported difficulties in using their device post-injury, 44% had received support, and 46% were interested in further training. Significant others reported motor/visual impairments and the fear of becoming dependent on technology as barriers for mobile device use, and 65% mentioned that their injured relative needed additional support. Mobile device use for cognition was common (64%), predicted in a regression model by lower subjective memory and more positive perception of the psychosocial impacts of technology, and also associated in univariate analyses with younger age, lower executive functioning, and greater use of memory strategies.

CONCLUSION

Using mobile devices for cognition is common post-ABI but remains challenging for a significant proportion. Developing training approaches may help supporting technology use.

Digital tools to support technology-enabled budget management in people with acquired brain injury: a rapid review

People with acquired brain injuries (ABI) face financial challenges that affect their daily lives. Managing finances is a crucial activity that can help avoid social isolation. However, this task becomes difficult for people with ABI because of their cognitive impairments. Recent advances in digital technology can help people with ABI manage their finances more effectively. This study aims to identify and describe available digital tools that can help ABI in budget management, and identify their effectiveness, barriers and facilitators to implementation. To address this issue, we conducted a rapid review of academic databases followed by a modified Google/Google Scholar search to identify the digital tools to support budgeting tasks (DBT) used and tested by people with ABI. Our rapid review included only two articles on the use of DBT. The first study showed that common portable electronic devices were acceptable and desirable as memory and organisational aids for people with ABI. The second study documented the development of a DBT and the perception of users (research participants) who found it appealing and user-friendly. However, for both articles, the technologies used are outdated and lack information on barriers and facilitators to using DBT. In conclusion, this literature review revealed that digital technologies have the potential to support budget management in people with ABI, but technology needs to be made available on the market to benefit the users. Further research and development are needed to create new ways to help people with brain injuries manage their budgets.

Co-developing 'The CyberABIlity Scale' to assess vulnerability to cyberscams for people with acquired brain injury: Delphi and cognitive interviews with clinicians and people with acquired brain injury

Background Although individuals with acquired brain injury (ABI) may be vulnerable to cyberscams, the lack of existing measures documenting cybersafety behaviours in people with ABI limits our understanding of ABI-specific risk factors, the frequency of this problem, and the ability to evaluate evidence-based interventions. The CyberABIlity Scale was developed to assess vulnerability in people with ABI via self-rated statements and practical scam-identification tasks. This study aimed to develop and refine The CyberABIlity Scale through feedback from clinicians and people with ABI. Methods Scale feedback was collected via three rounds of clinician surveys (n  = 14) using Delphi methods and two rounds of cognitive interviews with participants with ABI (n  = 8). Following each round, feedback was quantitatively and qualitatively summarised, and revisions were made accordingly. Results Key revisions included removing 12 items deemed irrelevant. Instructions and rating scales were revised to improve clarity. Cognitive interviews identified 15 comprehension errors, with further revisions made to support response clarity for participants with ABI. Clinicians and participants with ABI endorsed the content and face validities of The CyberABIlity Scale . Conclusions Following further validation, The CyberABIlity Scale has the potential to be an effective screening measure for online vulnerability for people with ABI within clinical and research settings.

"This group… I felt like I was medicating myself from this cyberscam illness that was living with me." A qualitative evaluation of co-designing cybersafety training resources with and for people with acquired brain injury

PURPOSE

Whilst anyone can be scammed, individuals with acquired brain injury (ABI) may have unique risk factors to cyberscams for which tailored interventions are required. To address this, a co-design approach was utilised to develop cybersafety resources with people with living experience of ABI and scams. This study aimed to evaluate the co-design experience to inform future utilisation of co-design methods.

METHOD

Semi-structured qualitative interviews explored perceived benefits and challenges, level of support and the co-design process for people with ABI (n= 7) and an attendant care worker (ACW) (n= 1). Transcripts were analysed using a six-stage reflexive thematic analysis.

RESULTS

Five themes were identified: "An Intervention Addressing Shame"; "Feeling Validated and Valued"; "Experiencing a 'Profound Change Amongst a Group of Peers'"; 'Gaining Stronger Scam Awareness'; and 'Taking Ownership'. Adjustments to support communication, memory impairments and fatigue in the co-design process were recommended.

CONCLUSIONS

Participant reflections on the co-design process extended beyond resource design and highlighted therapeutic benefits of increased insight and emotional recovery from shame. Likely mechanisms underpinning these benefits were the peer group format and opportunities to make meaningful contributions. Despite identified challenges in facilitating co-design projects, the practical and emotional benefits reported by participants underscore the value of co-design with people with ABI. Implications for rehabilitationIndividuals with acquired brain injury (ABI) may be at increased risk of cyberscams due to cognitive impairments, for which tailored cyberscam interventions are required.Using a co-design approach maximises the relevance of training resources for individuals with ABI.Using a collaborative co-design approach to developing cybersafety training resources may facilitate scam awareness and peer support.Support for communication, memory impairments and fatigue may be necessary in co-design efforts with people with ABI.

Clinician experiences with using assistive technology in brain injury rehabilitation: a survey of clinician capability, attitudes, and barriers

BACKGROUND

The rise in assistive technology (AT) solutions to support people with an acquired brain injury (ABI) has warranted clinicians to build capability in assisting clients to select goal-centred AT. The study explored, amongst ABI clinicians, (a) capability, attitudes, and barriers with AT implementation, (b) age-related differences in technology self-efficacy and capability (c) strategies to support AT use in rehabilitation and (d) thematic analysis of AT-related experiences.

METHOD

Mixed methods design. Online survey circulated to ABI clinicians across New South Wales, Australia, comprising purpose-designed items as well as the Modified Computer Self-Efficacy Scale (MCSES; range 0-100).

RESULTS

Clinicians (n = 123) were evenly distributed across decadal age groups. The majority were female (90%, n = 111) and one-third were occupational therapists.Clinicians scored strongly on the MCSES (Mdn = 76, IQR = 19), with younger age groups significantly associated with higher scores (H[3] = 9.667, p = .022). Most clinicians (92%) were knowledgeable of mainstream technology for personal use, but over half (65%) reported insufficient knowledge of suitable AT for clients. Clinicians reported positive attitudes towards AT, however, time to research and develop proficiency with a range of AT was the primary barrier (81%).Thematic analysis suggested that whilst the ideal AT experience is client-motivated requiring multidisciplinary guidance, the clinician role and experience with AT is evolving, influenced by rapid technological advancement and extrinsic opportunities to access AT.

CONCLUSIONS

Whilst clinicians have positive attitudes towards AT, there is a gap in clinician implementation. There is need to support further resources to build clinician capability and access to AT.

Early mobile app training proficiency predicts how well memory-impaired individuals learn to use digital memory aids in the real world

Functional memory impairment following acquired brain injury can lead to decreased independence. External memory aids such as smartphones can be highly effective compensation tools, but cognitive deficits may create barriers to implementation in daily life. The present study examined predictors of real-world use of mobile calendar applications for memory compensation in an acquired brain injury sample. A retrospective chart review was completed from an outpatient rehabilitation program, extending 15 years into the past, yielding data from 34 eligible participants. All participants demonstrated skill learning of the calendar function in their digital device and subsequently completed the generalization phase of training, which is focused on real-world implementation (measured through prospective memory tasks). The results showed that the length of time required for skill learning of mobile calendars (event entry or responding to alerts) was not predictive of the duration of generalization training. Initial training performance for responding to alerts, but not event entry, was a significant predictor of the duration of generalization training needed to complete the program. A secondary analysis with a subset of the data revealed that individuals with additional executive deficits took significantly longer to complete generalization training compared to those with a more focal memory impairment.

Evaluation of the Effectiveness of Assistive Technology for Executive Function Support for People With Acquired Brain Injury: Protocol for Single-Case Experimental Designs

BACKGROUND

Executive function, including prospective memory, initiating, planning, and sequencing everyday activities, is frequently affected by acquired brain injury (ABI). Executive dysfunction necessitates the use of compensatory cognitive strategies and, in more severe cases, human support over time. To compensate for the executive dysfunction experienced, growing options for electronic mainstream and assistive technologies may be used by people with ABI and their supporters.

OBJECTIVE

We outline the study protocol for a series of single-case experimental designs (SCEDs) to evaluate the effectiveness of smart home, mobile, and/or wearable technologies in reducing executive function difficulties following ABI.

METHODS

Up to 10 adults with ABI who experience executive dysfunction and have sufficient cognitive capacity to provide informed consent will be recruited across Victoria and New South Wales, Australia. Other key inclusion criteria are that they have substantial support needs for everyday living and reside in community dwellings. On the basis of the participant's identified goal(s) and target behavior(s), a specific electronic assistive technology will be selected for application. Both identification of the target behavior(s) and selection of the assistive technology will be determined via consultation with each participant (and their key support person, if applicable). The choice of SCED will be individualized for each participant based on the type of technology used in the intervention, the difficulty level of the behavior targeted for change, and the anticipated rate of change. For each SCED, repeated measurements of the target behavior(s) during the baseline condition will provide performance data for comparison with the performance data collected during the intervention condition (with technology introduced). Secondary outcome measures will evaluate the impact of the intervention. The protocol includes 2 customizable Microsoft Excel spreadsheets for electronic record keeping.

RESULTS

Recruitment period is June 2022 through March 2024. Trial results for the individual participants will be graphed and analyzed separately using structured visual analysis supplemented with statistical analysis. Analysis will focus on important features of the data, including both within- and between-phase comparisons for response level, trend, variability, immediacy, consistency, and overlap. An exploratory economic evaluation will determine the impact on formal and informal support usage, together with quality of life, following the implementation of the new technological intervention.

CONCLUSIONS

The study has been designed to test the cause-effect functional relationships between the intervention-in this case, electronic assistive technology-and its effect in changing the target behavior(s). The evaluation evidence gained will offer new insights into the application of various electronic assistive technologies for people who experience executive dysfunction following ABI. Furthermore, the results will help increase the capacity of key stakeholders to harness the potential of technology to build independence and reduce the cost of care for this population.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000835741, https://www.anzctr.org.au/ACTRN12622000835741.aspx.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48503.

Electronic Assistive Technology to Support Memory Function After Traumatic Brain Injury: A Systematic Review of Efficacy and User Perspectives

Abstract Rapid technology advances have led to diverse assistive technology (AT) options for use in memory rehabilitation after traumatic brain injury (TBI). This systematic review aimed to evaluate the efficacy of electronic AT for supporting phases of memory in daily life after TBI. A secondary aim was to examine user perspectives on the utility of AT and factors influencing uptake or use. A systematic search of PsycINFO, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (Embase), Scopus, and Cochrane Library was conducted from database inception to June 13, 2022, to identify eligible studies. Methodological quality was assessed by two independent reviewers. Nineteen eligible articles involving a total of 311 participants included four randomized controlled trials (RCTs; Class I), five single-case experimental designs (Class II), and 10 pre-post group (n > 10) or single-case studies without experimental control (Class III). Three Class I studies, two Class II studies and eight Class III studies supported the efficacy of AT for supporting memory functioning. Treatment fidelity was not examined in any study. There was the most empirical support for the efficacy of AT for facilitating retrieval and execution phases of memory (i.e., supported by 6/9 studies) with external support to encode memory intentions or pre-programmed reminders. Further controlled studies are needed to determine whether outcomes vary according to individuals' level of independence with use (e.g., self-initiated vs. pre-programmed reminders) and to examine user characteristics and design features influencing uptake and effectiveness. Greater involvement of end-users with brain injury in the design and evaluation of AT features is also recommended to enhance usability and uptake in daily life.

Development and Use of Assistive Technologies in Spinal Cord Injury: A Narrative Review of Reviews on the Evolution, Opportunities, and Bottlenecks of Their Integration in the Health Domain

Assistive technologies are increasingly taking a leading role in supporting people with spinal cord injury (SCI). This narrative review of reviews intends to contribute by making a map point investigating the integration of ATs in SCI. The methodology of the review was based on: (I) a search of PubMed and Scopus and (II) an eligibility assessment using specific parameters. The outcome highlighted the following: -The evolution of ATs considered in the context of SCI, considering ATs as both products and/or services in standalone and/or networked devices, and as processes of delivery. -Innovative technologies could play an important role in improving the quality of life and in minimizing costs in healthcare. -The international scientific community has identified ATs as one of the six strategic development areas in SCI. The overview also allowed the detection of some problems: (I) The ethical and regulatory aspects have been addressed in a weak way and only in specific and limited cases. (II) There is a lack of studies on the use and applications of ATs in SCI with a focus in multiple domains (e.g., costs, acceptance, dissemination, problems, regulatory aspects, ethical aspects, and other issues important for integration into the health domain). This review highlights the need for further studies and activities focused on integrating consensus in multiple domains, including ethics and regulations, to aid researchers and decision-makers in the field.

Change in care hours, cost, and functional independence following continence and assistive technology intervention in an acquired brain injury population

PURPOSE

After acquired brain injury (ABI) dependence on intervention for continence management is common. This preliminary investigation aimed to (i) quantify toileting care hours and costs in a community-based ABI rehabilitation and disability setting, and (ii) measure change in care needs, costs, and functional independence after intervention with assistive technologies (ATs).

METHOD

Pragmatic pre-post intervention pilot study of 14 adults with ABI and toileting disability accessing community-based neurorehabilitation or disability support in Western Australia. Toileting and functional independence were assessed monthly from baseline (T₀) to 3-month follow-up (T₃). Basic and nursing care hours (Northwick Park Dependency Score), cost of care estimates (Northwick Park Care Needs Assessment), functional independence (Functional Independence and Assessment Measure), and cost of consumables were examined pre- and post-intervention with ATs. Multilevel mixed-effects models with bootstrap estimation were conducted.

RESULTS

Cost of consumables significantly declined (AU$69/week), and functional independence significantly improved following intervention (+23.5 points). There was a non-significant reduction in care needs for toileting (4 h/week) and in the cost of toileting care (AU$633/week).

CONCLUSION

Toileting disability substantially impacts care hours and costs. This study provides preliminary evidence that comprehensive continence management is beneficial in reducing costs and supporting people with an ABI to increase their independence.IMPLICATIONS FOR REHABILITATIONA comprehensive continence assessment and management plan reduces the number of care hours, cost of care, and cost of continence products in a neurorehabilitation and disability support sample for people with acquired brain injury (ABI).Assistive technologies for continence management are beneficial in supporting people with ABI to increase independence, and reduce costs.Providing comprehensive continence assessment and management plan reduces reliance on staff for continence care, and improves functional independence.

Which training methods are effective for learning new smartphone memory apps after acquired brain injury? A pilot randomized controlled trial comparing trial and error, systematic instruction and error-based learning

This study aimed to compare the efficacy of three skills training methods (Trial and error TEL; systematic instruction SI; and error-based learning EBL) for training the use of a smartphone reminder app in individuals with an acquired brain injury. Participants (N = 38, M_age = 61.21 years, 71.1% stroke) were randomly allocated to one of three training conditions and trained over one two-hour session. Proficiency of performance with the trained app (primary outcome) was assessed immediately post-training, one- and six-weeks post-intervention. Secondary outcomes included generalization of skills, error commission, smartphone use frequency and confidence, and subjective memory complaints. Proficiency with the trained app after TEL was higher than SI immediately after the training (d = 0.87) and EBL at the one-week follow-up (d = 0.98). No differences were found six-weeks post-training. Smartphone use confidence increased at the six-week follow-up after TEL (d = 1.12) and EBL training (d = 0.91) but not after SI (d = 0.26). Self-reported memory complaints decreased across time for all groups (η_p² = 0.30). There was no clearly superior training method for optimizing proficiency with the reminder app. The expected benefits of SI and EBL may not have emerged due to the single-session format of the training. However, smartphone training via TEL or EBL has the potential to address confidence-related barriers to smartphone use.

Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions

Challenging behaviours are one of the most serious sequelae after a traumatic brain injury (TBI). These chronic behaviours must be managed to reduce the associated burden for caregivers, and people with TBI. Though technology-based interventions have shown potential for managing challenging behaviours, no review has synthesised evidence of technology aided behaviour management in the TBI population. The objective of this scoping review was to explore what technology-based interventions are being used to manage challenging behaviours in people with TBI. Two independent reviewers analysed 3505 studies conducted between 2000 and 2023. Studies were selected from five databases using search strategies developed in collaboration with a university librarian. Sixteen studies were selected. Most studies used biofeedback and mobile applications, primarily targeting emotional dysregulation. These technologies were tested in a variety of settings. Two interventions involved both people with TBI and their family caregivers. This review found that technology-based interventions have the potential to support behavioural management, though research and technology development is at an early stage. Future research is needed to further develop technology-based interventions that target diverse challenging behaviours, and to document their effectiveness and acceptability for use by people with TBI and their families.

Attentional Engagement During Mobile Application Skill Learning Among Patients With Memory Impairment: A Case Series Exploration

IMPORTANCE

Attentional engagement is essential for successful cognitive rehabilitation, but little is known about longitudinal interactions with skill learning.

OBJECTIVE

To examine how attentional engagement is associated with mobile application skill learning for memory compensation. We hypothesized that patients with greater functional capacity would demonstrate faster learning and attentional engagement drop with skill acquisition, whereas patients with lesser functional capacity would have to maintain attentional engagement to progress throughout training.

DESIGN

A case series approach was used with longitudinal skill learning and electroencephalographic (EEG) data recorded across multiple trials and sessions of mobile calendar application training.

SETTING

The study was run in a hospital-based neuropsychology clinic.

PARTICIPANTS

Seven participants (5 with acquired brain injury, 1 with mild cognitive impairment, and 1 healthy older adult) were recruited.

INTERVENTION

Mobile application operation was trained for the purpose of memory compensation. Skill learning was facilitated through a structured rehabilitation protocol, including large amounts of guided practice with the integration of errorless learning.

OUTCOMES AND MEASURES

We quantified learning using the proportion of application steps completed independently at each session. We measured attentional engagement using an EEG marker: the Brain Engagement Index.

RESULTS

For fast learners, attentional engagement generally decreased as mobile application learning progressed. In contrast, slow learners exhibited stable engagement over time with consistent, yet much slower, progress in skill learning.

CONCLUSIONS AND RELEVANCE

The present data indicate that when cognitive impairment is more substantial, skill learning may involve greater attentional engagement. What This Article Adds: Patients undergoing memory rehabilitation may benefit from methods to enhance attentional engagement during skill learning when executive dysfunction is a considerable element of their cognitive profile. Monitoring attentional engagement during cognitive rehabilitation may be useful in identifying and addressing barriers to learning in real time.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory

INTRODUCTION

Memory impairments affecting encoding, acquisition, and retrieval of information after moderate-to-severe traumatic brain injury (TBI) have debilitating and enduring functional consequences. The interventional research reviewed primarily focused on mild to severe memory impairments in episodic and prospective memory. As memory is a common focus of cognitive rehabilitation, clinicians should understand and use the latest evidence. Therefore, the INCOG ("International Cognitive") 2014 clinical practice guidelines were updated.

METHODS

An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for intervention for memory impairments post-TBI, a decision-making algorithm, and an audit tool for review of clinical practice.

RESULTS

The interventional research approaches for episodic and prospective memory from 2014 are synthesized into 8 recommendations (6 updated and 2 new). Six recommendations are based on level A evidence and 2 on level B. In summary, they include the efficacy of choosing individual or multiple internal compensatory strategies, which can be delivered in a structured or individualized program. Of the external compensatory strategies, which should be the primary strategy for severe memory impairment, electronic reminder systems such as smartphone technology are preferred, with technological advances increasing their viability over traditional systems. Furthermore, microprompting personal digital assistant technology is recommended to cue completion of complex tasks. Memory strategies should be taught using instruction that considers the individual's functional and contextual needs while constraining errors. Memory rehabilitation programs can be delivered in an individualized or mixed format using group instruction. Computer cognitive training should be conducted with therapist guidance. Limited evidence exists to suggest that acetylcholinesterase inhibitors improve memory, so trials should include measures to assess impact. The use of transcranial direct current stimulation (tDCS) is not recommended for memory rehabilitation.

CONCLUSION

These recommendations for memory rehabilitation post-TBI reflect the current evidence and highlight the limitations of group instruction with heterogeneous populations of TBI. Further research is needed on the role of medications and tDCS to enhance memory.

Digital divide among individuals with acquired brain injury: a scoping review protocol

OBJECTIVE

This scoping review will identify literature pertaining to individuals with an acquired brain injury and digital divide; specifically, examining personal access and use of internet-enabled information and communication technologies. The review will identify the information and communication technologies used by individuals with an acquired brain injury as well as the determinants of technology use. The review will also identify and create a taxonomy of information and communication technologies utilized in relation to cognitive and psychosocial outcomes for individuals with an acquired brain injury in community and outpatient settings.

INTRODUCTION

Internet-enabled technologies are increasingly central to all aspects of living, including health care and community participation; however, gaps in the access to and use of information and communication technologies among individuals with an acquired brain injury may limit the utility of a digitalized society.

INCLUSION CRITERIA

Studies that focus on access to or use of internet-enabled information and communication technologies among individuals with an acquired brain injury (including stroke, infection, tumor, disease, hypoxia, or traumatic brain injury) will be considered in this review.

METHODS

Primary peer-reviewed studies published in English from 2001 onward will be considered for inclusion. Six electronic databases will be searched: Embase, MEDLINE, Web of Science Core Collection, Google Scholar, CINAHL, and APA PsycINFO. Gray literature searches for government and nongovernment organization reports and data, and dissertation theses will be conducted via advanced Google searches. Two reviewers will independently screen titles, abstracts, and full texts of articles based on the "population, concept, context" inclusion criteria. Relevant data will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

PURPOSE OF REVIEW

Stroke is a common cause of disability in aging adults. A given individual's needs after stroke vary as a function of the stroke extent and location. The purpose of this review was to discuss recent clinical investigations addressing rehabilitation of an array of overlapping functional domains.

RECENT FINDINGS

Research is ongoing in the domains of movement, cognition, attention, speech, language, swallowing, and mental health. To best assist patients' recovery, innovative research has sought to develop and evaluate behavioral approaches, identify and refine synergistic approaches that augment the response to behavioral therapy, and integrate technology where appropriate, particularly to introduce and titrate real-world complexity and improve the overall experience of therapy. Recent and ongoing trials have increasingly adopted a multidisciplinary nature - augmenting refined behavioral therapy approaches with methods for increasing their potency, such as pharmaceutical or electrical interventions. The integration of virtual reality, robotics, and other technological advancements has generated immense excitement, but has not resulted in consistent improvements over more universally accessible, lower technology therapy.

Efficacy of Prospective Memory Rehabilitation Plus Metacognitive Skills Training for Adults With Traumatic Brain Injury: A Randomized Controlled Trial

BACKGROUND

Prospective memory (PM) failure can limit independence and productivity following traumatic brain injury (TBI). Compensatory strategy use may ameliorate the effect of PM impairment on daily life but requires sufficient self-awareness. Metacognitive skills training (MST) can facilitate self-awareness and strategy use and may improve the efficacy of PM rehabilitation.

OBJECTIVE

To evaluate the effectiveness of compensatory strategy training (COMP) with an MST component (COMP-MST) for reducing everyday PM failure and improving psychosocial integration in adults with moderate-severe TBI, compared to COMP alone and a control condition. Secondary aims were to evaluate the effect of training on psychometric PM test scores, strategy use, self-awareness, and level of care.

METHODS

Assessor and participant-blinded randomized controlled trial with 52 participants (77% male, mean age = 39.0. SD = 13.6) allocated to 3 groups: COMP-MST, COMP, and waitlist control. Interventions were delivered over 6 weekly sessions. Measures were collected pre- and post-intervention and 3-month follow-up. Data were analyzed using unstructured linear mixed-effects modeling for repeated measures and planned contrasts between time-points for each group.

RESULTS

The models showed no significant differences between the groups on primary or secondary outcome measures. Significant pre-post intervention improvements were found for significant other's ratings of everyday PM failure for both intervention groups but not the control group, with medium to large effect sizes. Clinically relevant improvements on primary outcomes were found for participants across all 3 groups.

CONCLUSIONS

This study found no significant benefits of combining MST with COMP for improving everyday PM and psychosocial integration.

CLINICAL TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry https://www.anzctr.org.au/ ACTRN12615000996561.

Development of RehaBot-A Conversational Agent for Promoting Rewarding Activities in Users With Traumatic Brain Injury

OBJECTIVE

In this article, we describe the development and preliminary testing of RehaBot-a chatbot that users communicate with via text messaging designed to augment behavioral activation (BA) treatment of reducing depression and increasing participation in individuals with moderate to severe traumatic brain injury (TBI).

SETTING

Outpatient brain injury rehabilitation facility.

PARTICIPANTS

Outpatient brain injury clinicians and individuals with moderate to severe TBI.

DESIGN

Focus groups, software demonstration trials, and single-case experiments with an A-B-A design.

MAIN MEASURES

System Usability Scale (SUS) and self-reported completed target activities.

RESULTS

Focus group feedback guided the development of a flexible system to be used in conjunction with face-to-face therapy, designed to provide reminders, encouragement, and supportive feedback. Two of 3 participants completed all 6 RehaBot tasks independently. One completed 4 tasks independently and a fifth with assistance. Average SUS score in demonstration trials was 76.77 (SD = 21.19). In 4 single-case experiments, participants completed their highest proportion of planned activities in the RehaBot phase and the lowest proportion of planned activities in the reversal phase. They all interacted with RehaBot daily, exchanging an average of 225 messages over the 1-week period, and average SUS score was 95 (SD = 4.74). Their open-ended feedback revealed that participants found RehaBot enjoyable and easy to use. They felt it was a helpful memory aid and promoted better adherence to planned activities by providing accountability and positive reinforcement.

CONCLUSIONS

This article presents a chatbot development process heavily involving consumer input, which may serve as a model for future development efforts. Our findings provide preliminary evidence suggesting that RehaBot is usable and may promote better adherence to planned target activities. However, future research is needed to establish usability and efficacy of RehaBot and to explore applications of chatbots to other domains of TBI rehabilitation.

Partnering a Compensatory Application with Activity-Aware Prompting to Improve Use in Individuals with Amnestic Mild Cognitive Impairment: A Randomized Controlled Pilot Clinical Trial

BACKGROUND

Compensatory aids can help mitigate the impact of progressive cognitive impairment on daily living.

OBJECTIVE

We evaluate whether the learning and sustained use of an Electronic Memory and Management Aid (EMMA) application can be augmented through a partnership with real-time, activity-aware transition-based prompting delivered by a smart home.

METHODS

Thirty-two adults who met criteria for amnestic mild cognitive impairment (aMCI) were randomized to learn to use the EMMA app on its own (N = 17) or when partnered with smart home prompting (N = 15). The four-week, five-session manualized EMMA training was conducted individually in participant homes by trained clinicians. Monthly questionnaires were completed by phone with trained personnel blind to study hypotheses. EMMA data metrics were collected continuously for four months. For the partnered condition, activity-aware prompting was on during training and post-training months 1 and 3, and off during post-training month 2.

RESULTS

The analyzed aMCI sample included 15 EMMA-only and 14 partnered. Compared to the EMMA-only condition, by week four of training, participants in the partnered condition were engaging with EMMA more times daily and using more basic and advanced features. These advantages were maintained throughout the post-training phase with less loss of EMMA app use over time. There was little differential impact of the intervention on self-report primary (everyday functioning, quality of life) and secondary (coping, satisfaction with life) outcomes.

CONCLUSION

Activity-aware prompting technology enhanced acquisition, habit formation and long-term use of a digital device by individuals with aMCI. (ClinicalTrials.gov NCT03453554).

Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic

The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.

The experience and acceptability of smartphone reminder app training for people with acquired brain injury: a mixed methods study

Smartphones are useful compensatory memory aids, yet training on how to use them is seldom offered as part of rehabilitation for acquired brain injuries (ABIs). We aimed to explore the experience and acceptability of a smartphone training intervention in 26 people with ABI who participated in a pilot randomized controlled trial comparing three skills training approaches. Participants completed questionnaire ratings and a semi-structured interview, six weeks post-training. Most participants rated the training as enjoyable (80.8%) and reasonable in duration (88.5%). Others reported that more than one training session was needed to learn the app (34.6%). Five themes were identified from qualitative data through thematic analysis: (1) Attitudes and pre-existing factors, (2) Experiencing the intervention, (3) Tailoring the intervention to the individual, (4) Facilitators and barriers to implementation and (5) Enhancing smartphone use in everyday life. These themes were juxtaposed with a theoretical framework of acceptability, which indicated that some elements (e.g., having a structured session and a supportive trainer) contributed to the acceptability of the intervention by minimizing training burden and increasing self-efficacy. Tailoring the training to the individual's technological skills and lifestyle, providing post-training resources and involving family members were identified as factors that could improve intervention acceptability.

Mobile app learning in memory intervention for acquired brain injury: Neuropsychological associations of training duration

Memory impairment is a common consequence of acquired brain injury, often leading to functional difficulties day-to-day and decreased independence. Memory Link is a theory-driven training programme for individuals with moderate-to-severe memory dysfunction, which enables the acquisition of digital device skills for functional compensation. The present study examined how neuropsychological functioning and initial training performance contribute to training duration in our outpatient memory rehabilitation programme. A retrospective chart review was conducted, extending 12 years into the past, yielding data from 37 eligible participants. All participants demonstrated skill learning of the calendar function in their digital device to the criterion point. The results showed that performance on neuropsychological tests of explicit memory (e.g., CVLT-II, BVMT-R), processing speed (e.g., Digit Symbol Coding, Trail Making sequencing), executive functioning (e.g., Trail Making switching), and perceptual ability (i.e., Block Design) were significantly associated with training duration to learn the core steps of calendar use. Furthermore, linear regression revealed that initial training performance was a significant predictor of training duration. Lastly, profile of cognitive impairment, with regard to severity of memory functioning and the presence of additional deficits, was found to be a significant factor contributing to how many training trials were required to learn application skills.

Occupational performance goals and outcomes of time-related interventions for children with ADHD

BACKGROUND

Children with attention deficit hyperactivity disorder (ADHD) have difficulties with occupational performance, related to difficulties with time-processing ability.

AIMS

To examine the outcome of a multimodal time-related intervention designed to support children aged 9-15 years with ADHD, to achieve their occupational performance goals and improve satisfaction with occupational performance. A further aim was to compare the children's ratings of outcome with their parents' ratings and to analyse the occupational performance goals.

MATERIAL AND METHODS

A pre-post design was used. Participants were 27 children, aged 9-15 years. Children and parents rated occupational performance and satisfaction at baseline and follow-up, after 24 weeks, using the Canadian Occupational Performance Measure (COPM). The intervention consisted of time-skills training and time-assistive devices (TADs). Descriptive and non-parametric statistics were used.

RESULTS

Significant improvements were found in reported performance and satisfaction. Children's were higher than those of their parents. Most goals were about carrying out daily routines, knowing the duration of an activity and knowing what will happen in the near future.

CONCLUSION AND SIGNIFICANCE

The study contributes to knowledge about suitable interventions for children with ADHD who have time-related difficulties. Occupational therapy interventions, including TADs and time-skills training, resulted in significantly improved occupational performance.

A comparison of systematic instruction, error-based learning and trial and error to train the use of smartphone memory apps after acquired brain injury: A three-armed phase II randomised controlled trial study protocol

Background:

The uptake of smartphones as external compensatory memory aids following an acquired brain injury (ABI) in rehabilitation settings is low. Potential reasons for this include professionals not having evidence-based guidelines regarding the best methods to train smartphone use and prospective users not being familiar with technology and/or having memory and learning difficulties. This paper describes the protocol of a study that aims to compare the efficacy of three training methods (Systematic Instruction, Error-based Learning and Trial-and-Error) for training the use of a smartphone reminder app, in people with ABI presenting with memory complaints.

Methods/Design:

This is a three-armed, assessor-blinded, Phase II randomised controlled trial. The estimated sample size is 51 participants aged >18 years, who are equally randomised to one of the three training groups. They are seen across four sessions: one to conduct baseline measures; one for training the use of an app and two for follow-up assessments (1- and 6-weeks post-training). The main outcome measure is proficiency of performance in tasks with the trained app. Secondary outcomes include generalisation of skills to other apps, number of errors committed while attempting the tasks, frequency of smartphone usage in general and as a memory aid and confidence in smartphone use and memory self-efficacy. Outcome measures are collected by an independent blinded assessor. Proficiency of performance, generalisation of skills and error commission are measured immediately post-training and at the two follow-up sessions. The other secondary measures are taken pre-intervention and at the two follow-up sessions.

Discussion:

This study will provide initial evidence regarding the efficacy of three different methods to train ABI survivors with memory difficulties in how to use smartphone apps as compensatory memory aids. The results could inform a larger Phase III trial and advance knowledge concerning the advantages or disadvantages of using error-reducing and trial-and-error techniques. Further, the findings could determine the potential of error-based learning as an emerging training method for people with memory impairment within rehabilitation.

Information and communication technology-based assistive technology to compensate for impaired cognition in everyday life: a systematic review

Purpose: A systematic review was performed evaluating the effectiveness of Information and Communication Technology-based Assistive Technology (ICT-based-AT) to compensate for impaired cognition in everyday life activities.Materials and methods: The study was registered in PROSPERO, registration number CRD42018114913. Six databases were searched (years 2008-2019).Inclusion criteria: Randomized controlled trials (RCTs) or cohort studies; people with impaired cognition due to non-degenerative diseases; and evaluation of ICT-based-ATs' effectiveness regarding activity and participation, including prospective memory, execution of tasks and satisfaction with task execution. Each study's level of evidence and quality were assessed using "JBI Levels of Evidence" and the "JBI Meta-Analysis of Statistics Assessment and Review Instrument", respectively.Results: About 3,153 publications were located, of which 12 were included. The levels of evidence were: 1.c (RCT) (n = 7), 1.d (pseudo-RCT) (n = 1) and 3.e (observational study without control group) (n = 4). Three studies had high quality (2 RCT/1 cohort), eight acceptable (5 RCT/3 cohort) and one low (RCT) quality.Conclusions: Smartphones, personal digital assistants (PDAs), etc. with e.g. calendars and reminder alarms can improve prospective memory, especially for people with ABI. Furthermore, PDAs and similar products with prompts can improve execution of tasks for people with cognitive impairment due to different diagnoses. Products should be tailored to the users' needs and the users trained in product use. Further studies concerning children, older people and people with intellectual and developmental disability are required; as well as studies on cost-effectiveness and the effectiveness of related services.Implications for rehabilitationIn order to support activity and participation in everyday life for people with prospective memory problems, especially people with acquired brain injury, they should be offered information and communication technology-based products, such smart phones, mobile phones, personal digital assistants or similar mainstream products equipped with reminding software.People with cognitive impairment having difficulties executing tasks independently should be offered PDAs and mobile telephones and similar products with prompting software, e.g. audio-verbal, picture and video-based task-sequencing prompts.The ICT-based products should be individually tailored, and the person should be trained in using the selected product.

Damage-associated molecular patterns in trauma

In 1994, the “danger model” argued that adaptive immune responses are driven rather by molecules released upon tissue damage than by the recognition of “strange” molecules. Thus, an alternative to the “self versus non-self recognition model” has been provided. The model, which suggests that the immune system discriminates dangerous from safe molecules, has established the basis for the future designation of damage-associated molecular patterns (DAMPs), a term that was coined by Walter G. Land, Seong, and Matzinger. The pathological importance of DAMPs is barely somewhere else evident as in the posttraumatic or post-surgical inflammation and regeneration. Since DAMPs have been identified to trigger specific immune responses and inflammation, which is not necessarily detrimental but also regenerative, it still remains difficult to describe their “friend or foe” role in the posttraumatic immunogenicity and healing process. DAMPs can be used as biomarkers to indicate and/or to monitor a disease or injury severity, but they also may serve as clinically applicable parameters for optimized indication of the timing for, i.e., secondary surgeries. While experimental studies allow the detection of these biomarkers on different levels including cellular, tissue, and circulatory milieu, this is not always easily transferable to the human situation. Thus, in this review, we focus on the recent literature dealing with the pathophysiological importance of DAMPs after traumatic injury. Since dysregulated inflammation in traumatized patients always implies disturbed resolution of inflammation, so-called model of suppressing/inhibiting inducible DAMPs (SAMPs) will be very briefly introduced. Thus, an update on this topic in the field of trauma will be provided.

A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries

Objective:

This review aimed to determine the effectiveness of personal smart technologies on outcomes in adults with acquired brain injury.

Data sources:

A systematic literature search was conducted on 30 May 2019. Twelve electronic databases, grey literature databases, PROSPERO, reference list and author citations were searched.

Methods:

Randomised controlled trials were included if personal smart technology was used to improve independence, goal attainment/function, fatigue or quality of life in adults with acquired brain injury. Data were extracted using a bespoke form and the TIDieR checklist. Studies were graded using the PEDro scale to assess quality of reporting. Meta-analysis was conducted across four studies.

Results:

Six studies met the inclusion criteria, generating a total of 244 participants. All studies were of high quality (PEDro ⩾ 6). Interventions included personal digital assistant, smartphone app, mobile phone messaging, Neuropage and an iPad. Reporting of intervention tailoring for individual needs was inconsistent. All studies measured goal attainment/function but none measured independence or fatigue. One study ( n = 42) reported a significant increase in memory-specific goal attainment ( p = 0.0001) and retrospective memory function ( p = 0.042) in favour of the intervention. Another study ( n = 8) reported a significant increase in social participation in favour of the intervention ( p = 0.01). However, our meta-analyses found no significant effect of personal smart technology on goal attainment, cognitive or psychological function.

Conclusion:

At present, there is insufficient evidence to support the clinical benefit of personal smart technologies to improve outcomes in acquired brain injury. Researchers need to conduct more randomised studies to evaluate these interventions and measure their potential effects/harms.

Health, wellness, and safety concerns of persons with moderate-to-severe traumatic brain injury and their family caregivers: a qualitative content analysis

BACKGROUND

Persons with moderate-to-severe traumatic brain injury (TBI) face issues with health, wellness, and safety that affect their ability to independently manage their care, even for individuals who are ≥75% independent in activities of daily living. These issues often lead to increased family involvement in managing the person's condition after discharge home.

PURPOSE

We explored health, wellness, and safety concerns after discharge home from inpatient rehabilitation from the perspectives of persons with TBI who are ≥75% independent in activities of daily living and their family caregivers.

MATERIALS AND METHODS

We interviewed 27 persons with TBI and family caregivers and used conventional content analysis to analyse the data.

RESULTS

Seven themes related to health, wellness, and safety encompassed participants' experience. Health themes included: (1) attempting to manage medications and (2) navigating mental health difficulties. Wellness themes included: (1) working to stay physically active, (2) dealing with sleep and sleeplessness, and (3) adjusting to changing social relationships. Safety themes were: (1) addressing mobility challenges and (2) compensating for complications with cognitive functioning.

CONCLUSIONS

Findings can guide the development of tools, supports, and resources to promote health, wellness, and safety of persons with TBI as they recover after discharge home.Implications for rehabilitationFindings on numerous concerns related to health, wellness, and safety suggest the need for implementation or development and testing of tools, supports, and resources to promote health, wellness, and safety of persons with traumatic brain injury as they recover after discharge home.Our findings can be used to educate healthcare providers and increase awareness of the nuanced challenges patients and families face after discharge home.Findings can also be used by providers to educate patients and families on realistic expectations for life after discharge.

Informing evaluation of a smartphone application for people with acquired brain injury: a stakeholder engagement study

BACKGROUND

Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement.

METHODS

We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire responses.

RESULTS

We engaged with 20 ABI survivors, 5 carers, 25 professionals, 41 questionnaires were completed by stakeholders. Comments made during group discussions were supported by questionnaire results. Enablers included smartphone competency (capability), personalisation of app (opportunity), and identifying perceived need (motivation). Barriers included a physical and cognitive inability to use smartphone (capability), potential cost and reliability of technology (opportunity), and no desire to use technology or change from existing strategies (motivation). The stakeholders identified potential uses and changes to the app, which were not easily mapped onto the behaviour change wheel, e.g. monitoring fatigue levels, method of logging task completion, and editing the diary on their smartphone.

CONCLUSIONS

The study identified that both ABI survivors and therapists could see a use for Brain in Hand, but wanted users to be able to personalise it themselves to address individual user needs, e.g. monitoring activity levels. The behaviour change wheel is a useful tool when designing and evaluating engagement activities as it addresses most aspects of implementation, however additional categories may be needed to explore the specific features of assistive technology interventions, e.g. technical functions.

Efficacy of memory aids after traumatic brain injury: A single case series

BACKGROUND

Individuals living with traumatic brain injury commonly have difficulties with prospective memory-the ability to remember a planned action at the intended time. Traditionally a memory notebook has been recommended as a compensatory memory aid. Electronic devices have the advantage of providing a cue at the appropriate time to remind participants to refer to the memory aid and complete tasks. Research suggests these have potential benefit in neurorehabilitation.

OBJECTIVE

This study aimed to investigate the efficacy of a memory notebook and specifically a smartphone as a compensatory memory aid.

METHODS

A single case series design was used to assess seven participants. A no-intervention baseline was followed by training and intervention with either the smartphone alone, or a memory notebook and later the smartphone. Memory was assessed with weekly assigned memory tasks.

RESULTS

Participants using a smartphone showed improvements in their ability to complete assigned memory tasks accurately and within the assigned time periods. Use of a smartphone provided additional benefits over and above those already seen for those who received a memory notebook first.

CONCLUSIONS

Smartphones have the potential to be a useful and cost effective tool in neurorehabilitation practice.

Effectiveness of time-related interventions in children with ADHD aged 9-15 years: a randomized controlled study

Specific problems with time and timing that affect daily routines, homework, school work, and social relations have been recognized in children with ADHD. The primary treatments for children with ADHD do not specifically focus on time-related difficulties. The aim of this randomized controlled study (RCT) was to investigate how multimodal interventions, consisting of training in time-processing ability (TPA) and compensation with time-assistive devices (TAD), affect TPA and daily time management (DTM) in children with ADHD and time difficulties, compared with only educational intervention. Thirty-eight children on stable medication for ADHD in the 9-15-year age range were randomly allocated to an intervention or a control group. The children's TPA was measured with a structured assessment (KaTid), and the children's DTM was rated by a parent questionnaire (Time-Parent scale) and by children's self-reporting (Time-Self-rating). The intervention consisted of time-skill training and compensation with TAD. Data were analysed for differences in TPA and in DTM between the control and intervention groups in the 24-week follow-up. Children in the intervention group increased their TPA significantly (p = 0.019) more compared to the control group. The largest increase was in orientation to time. In addition, the parents in the intervention group rated their children's DTM as significantly (p = 0.01) improved compared with the parents in the control group. According to the children, their DTM was not significantly changed. In conclusion, a multimodal intervention consisting of time-skill training and TAD improved TPA and DTM in children with ADHD aged 9-15 years.

Virtual peer-delivered memory intervention: a single-case experimental design in an adolescent with chronic memory impairment

BACKGROUND

Children and adolescents with chronic memory impairment may develop coping strategies that enable functioning, yet these often remain undetectable using traditional psychometric measures. Personalized intervention studies that promote the use of such strategies designed specifically for use by this young cohort are scarce.

OBJECTIVE

To investigate the effect of a novel virtual reality peer-delivered memory intervention on the everyday functioning and well-being of SE, a 17-year-old female with a history of chronic verbal memory issues, impaired autobiographical event recall and elevated mood symptoms.

RESEARCH DESIGN

A single-case ABA experimental design study was used to assess change.

METHODS

Following initial baseline assessment using objective neuropsychological and subjective functional questionnaires and intervention training, case SE used the intervention daily for 3 weeks before repeating key outcome measures.

RESULTS

Using non-overlap of all pairs and qualitative feedback analysis, the results revealed a significant increase in event recall and self-reported positive changes to levels of everyday functioning.

CONCLUSION

Supporting autobiographical event recall and prospective memory via a virtual peer-delivered intervention may lead to reduction in cognitive load, and benefit overall well-being and everyday functioning.

Assessing Features of Psychometric Assessment Instruments: A Comparison of the COSMIN Checklist with Other Critical Appraisal Tools

The past 20 years have seen the development of instruments designed to specify standards and evaluate the adequacy of published studies with respect to the quality of study design, the quality of findings, as well as the quality of their reporting. In the field of psychometrics, the first minimum set of standards for the review of psychometric instruments was published in 1996 by the Scientific Advisory Committee of the Medical Outcomes Trust. Since then, a number of tools have been developed with similar aims. The present paper reviews basic psychometric properties (reliability, validity and responsiveness), compares six tools developed for the critical appraisal of psychometric studies and provides a worked example of using the COSMIN checklist, Terwee-m statistical quality criteria, and the levels of evidence synthesis using the method of Schellingerhout and colleagues (2012). This paper will aid users and reviewers of questionnaires in the quality appraisal and selection of appropriate instruments by presenting available assessment tools, their characteristics and utility.

Do Smartphones have the Potential to Support Cognition and Independence Following Stroke?

Management of cognitive difficulties is a significant unmet need for individuals with stroke. Incorporating multiple functions, including memory aids and communication tools, smartphones have potential to improve everyday cognitive function and independence in daily activities post-stroke. We aimed to investigate patterns of smartphone use, facilitators and barriers to use, and relationships between smartphone use and daily functioning. Twenty-nine participants with stroke and 29 comparison participants with no history of neurological conditions completed measures of smartphone use, objective and subjective cognitive function, mood and community integration. The majority of participants used smartphones, though the proportion of users was lower in the stroke group (62%) than the comparison group (86%). Older participants were less likely to use smartphones. Using apps that support memory was a main benefit of smartphone use post-stroke. In the stroke group, frequent users of memory apps had significantly fewer motor symptoms (d = 1.20), and higher productivity (d = 0.84). Stroke survivors identified difficulty learning how to use smartphones, but only one participant had assistance with this from a clinician. These results suggest that smartphones have potential as assistive technology post-stroke, however, support in using them is essential, particularly for older individuals with motor dysfunction.

Integrating cognitive rehabilitation: A preliminary program description and theoretical review of an interdisciplinary cognitive rehabilitation program

BACKGROUND

Interdisciplinary cognitive rehabilitation is emerging as the expected standard of care for individuals with mild to moderate degrees of cognitive impairment for a variety of etiologies. There is a growing body of evidence in cognitive rehabilitation literature supporting the involvement of multiple disciplines, with the use of cognitive support technologies (CSTs), in delivering cognitive therapy to individuals who require cognitive rehabilitative therapies. This article provides an overview of the guiding theories related to traditional approaches of cognitive rehabilitation and the positive impact of current theoretical models of an interdisciplinary approach in clinical service delivery of this rehabilitation.

OBJECTIVE

A theoretical model of the Integrative Cognitive Rehabilitation Program (ICRP) will be described in detail along with the practical substrates of delivering specific interventions to individuals and caregivers who are living with mild to moderate cognitive impairment. The ultimate goal of this article is to provide a clinically useful resource for direct service providers. It will serve to further clinical knowledge and understanding of the evolution from traditional silo based treatment paradigms to the current implementation of multiple perspectives and disciplines in the pursuit of patient centered care.

METHODS

The article will discuss the theories that contributed to the development of the interdisciplinary team and the ICRP model, implemented with individuals with mild to moderate cognitive deficits, regardless of etiology. The development and implementation of specific assessment and intervention strategies in this cognitive rehabilitation program will also be discussed.

RESULTS

The assessment and intervention strategies utilized as part of ICRP are applicable to multiple clinical settings in which individuals with cognitive impairment are served.

CONCLUSIONS

This article has specific implications for rehabilitation which include: (a) An Interdisciplinary Approach is an effective method for cognitive rehabilitation; and (b) Recent theories offer beneficial evaluation and intervention techniques for cognitive rehabilitation.

Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury

Traumatic brain injury (TBI) is among the significant causes of morbidity and mortality in the present world. Around 1.6 million persons sustain TBI, whereas 200,000 die annually in India, thus highlighting the rising need for appropriate cognitive rehabilitation strategies. This literature review assesses the current knowledge of various cognitive rehabilitation training strategies. The entire spectrum of TBI severity; mild to severe, is associated with cognitive deficits of varying degree. Cognitive insufficiency is more prevalent and longer lasting in TBI persons than in the general population. A multidisciplinary approach with neuropsychiatric evaluation is warranted. Attention process training and tasks for attention deficits, compensatory strategies and errorless learning training for memory deficits, pragmatic language skills and social behavior guidance for cognitive-communication disorder, meta-cognitive strategy, and problem-solving training for executive disorder are the mainstay of therapy for cognitive deficits in persons with TBI. Cognitive impairments following TBI are common and vary widely. Different cognitive rehabilitation techniques and combinations in addition to pharmacotherapy are helpful in addressing various cognitive deficits.

First steps in designing an all-in-one ICT-based device for persons with cognitive impairment: evaluation of the first mock-up

Background

This project Smart Assisted Living involving Informal careGivers++ (SALIG) intends to develop an ICT-based device for persons with cognitive impairment combined with remote support possibilities for significant others and formal caregivers. This paper presents the identification of the target groups’ needs and requirements of such device and the evaluation of the first mock-up, demonstrated in a tablet.

Methods

The inclusive design method that includes end-users in the design process was chosen. First, a scoping review was conducted in order to examine the target group’s need of an ICT-based device, and to gather recommendations regarding its design and functionalities. In order to capture the users’ requirements of the design and functionalities of the device three targeted focus groups were conducted. Based on the findings from the publications and the focus groups a user requirement specification was developed. After that a design concept and a first mock-up was developed in an iterative process. The mock-up was evaluated through interviews with persons with cognitive impairment, health care professionals and significant others. Data were analysed using content analysis.

Results

Several useful recommendations of the design and functionalities of the SALIG device for persons with cognitive impairment were identified. The main benefit of the mock-up was that it was a single device with a set of functionalities installed on a tablet and designed for persons with cognitive impairment. An additional benefit was that it could be used remotely by significant others and formal caregivers.

Conclusion

The SALIG device has the potentials to facilitate everyday life for persons with cognitive impairment, their significant others and the work situation for formal caregivers. The results may provide guidance in the development of different types of technologies for the target population and for people with diverse disabilities. Further work will focus on developing a prototype to be empirically tested by persons with cognitive impairment, their significant others and formal caregivers.