Google Calendar: A single case experimental design study of a man with severe memory problems

Implementing neuropsychological rehabilitation following severe traumatic brain injury in a low-to-middle income country: a case report

Introduction

TBI incidence and distribution are largely overrepresented in low- to middle-income countries (LMICs), such as South Africa (SA), with substantial associated human and financial costs. However, access to rehabilitation for the public is severely limited and not standard practice in SA. Given this background, studies demonstrating the successful implementation of neuropsychological rehabilitation in a LMIC setting are important. Published studies of this nature are generally lacking in this context. Further, there is a need to evaluate interventions that can be implemented at a low cost. To this end, we report on a neuropsychological rehabilitation program for an individual with severe TBI in a LMIC context, aimed at improving his capacity for activities of daily living.

Method

A 33-year-old, South African male who sustained a severe traumatic brain injury (TBI) partook in a neuropsychological intervention aimed at remediating functional deficits and enhancing independent functioning. The intervention utilised principles of Goal Management Training and external memory aids, with reliance on procedural memory and errorless learning, to target the participant's impairments in executive functioning and memory through the use of assistive technology-namely smart device applications.

Results

Data collected pre- and post-intervention on formal neuropsychological measures demonstrated no significant change in cognition. However, observational data and qualitative feedback from the participant's family indicated notable improvement in performance on everyday tasks with reduced number of errors and reduced need for external prompting whilst completing intervention tasks across sessions.

Discussion

In the context of severe TBI, neuropsychological rehabilitation can facilitate gains in independent functioning. This study provides support for the value of neurorehabilitation especially for interventions that can be rolled out at low cost and should serve as impetus for further such research in South Africa, where neuropsychological rehabilitation infrastructure and services are lacking.

Efficacy of Digital and Non-Digital Compensatory Strategies in Supporting Prospective Memory Task Completion among Community-Dwelling Mid-Life and Older Adults

OBJECTIVE

Compensatory strategies can be used to help mid-life and older adults successfully manage instrumental activities of daily living that rely upon prospective memory. This study compared the quality of digital and non-digital compensatory strategies in supporting accurate completion of naturalistic, real-world prospective memory tasks.

METHOD

Participants included 70 community-dwelling mid-life and older adults. In this cross-sectional study, participants were tested remotely via Zoom in their homes. They were tasked with completing four real-world prospective memory tasks and encouraged to use their typical compensatory strategies. Utilized strategies were categorized, counted, and assigned quality scores (rating of thoroughness and utility), and prospective memory performance was coded.

RESULTS

Participants who used any digital strategies utilized significantly more (ηp2 = .17) and better quality (ηp2 = .12) strategies than participants who did not use any digital strategies. However, the groups demonstrated equivalent prospective memory performance (ηp2 = .006). Within the digital group, participants' digital and non-digital strategies were of similar quality (d = .14) and resulted in similar prospective memory task accuracy (d = .01).

CONCLUSIONS

Digital and non-digital strategies led to similar performance on naturalistic prospective memory tasks. Findings suggest that many different types of strategies can provide adequate prospective memory support to healthy mid-life and older adults. To inform development of compensatory strategy interventions, future studies should explore other factors that lead to successful prospective memory, such as the specific strategy type and task type match, across the continuum of cognitive impairment.

Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury

BACKGROUND

Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts.

PRIMARY OBJECTIVE

To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry.

REVIEW OF INFORMATION

Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus.

OUTCOMES

This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.

Typicality of Level Change (TLC) as an Additional Effect Measure to NAP and Tau-U in Single Case Research

Single case research is a viable way to obtain evidence for social and psychological interventions on an individual level. Across single case research studies various analysis strategies are employed, varying from visual analysis to the calculation of effect sizes. To calculate effect sizes in studies with few measurements per time period (<40 data points with a minimum of five data points in each phase), non-parametric indices such as Nonoverlap of All Pairs (NAP) and Tau-U are recommended. However, both indices have restrictions. This article discusses the restrictions of NAP and Tau-U and presents the description, calculation, and benefits of an additional effect size, called the Typicality of Level Change (TLC) index. In comparison to NAP and Tau-U, the TLC index is more aligned to visual analysis, not restricted by a ceiling effect, and does not overcompensate for problematic trends in data. The TLC index is also sensitive to the typicality of an effect. TLC is an important addition to ease the restrictions of current nonoverlap methods when comparing effect sizes between cases and studies.

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.

Utility of a novel tablet computer software for memory impairment in participants with brain injuries: A randomized control trial

This study examined the effectiveness of a novel information and communication technology (ICT) tool developed for external memory compensation to improve memory function in participants with brain injuries. In this 3-month randomized control study, participants with memory impairment secondary to brain injury were randomly assigned on a 1:1 basis to either intervention (the ICT tool [ARATA]) or 3-month waitlist control groups. This study's primary outcome measure was memory-related difficulties in everyday life, assessed using the Everyday Memory Checklist (EMC). Secondary outcomes included tests for memory function and psychosocial status, all of which were administered by blinded assessors. Seventy-eight participants (53 males, 25 females; mean age, 43.5 ± 12.7 [SD] years) were enrolled and 39 participants were allocated to each group (intervention and control). There was no significant difference in EMC scores between the two groups throughout the study (mean 0.26; 95% CI: -2.55-3.07; p=0.853); however, the intervention group scored significantly higher on the Rivermead Behavioural Memory and General Self-Efficacy tests compared to the control group. While the ICT tool did not improve the primary study outcome, evidence suggests that the ICT tool can improve memory functions related to activities of daily living.

MindMate: A single case experimental design study of a reminder system for people with dementia

Prospective memory difficulties are commonly reported in people with dementia. The evidence supporting the use of prospective memory devices among the dementia population remains limited. MindMate is a recently developed smart device application that aims to support individuals with a diagnosis of dementia, improving self-management skills and quality of life. This study investigated the effectiveness and usability of the reminder tool on the MindMate application as a memory aid. Three participants with a diagnosis of Alzheimer's disease were recruited to this multiple baseline single-case experimental design study. Partners of the participants recorded their performance on everyday tasks on weekly monitoring forms during a baseline phase (between five and seven weeks) and during the intervention phase (five weeks) whilst using MindMate. Two participants successfully used the app throughout the intervention weeks and gave positive usability ratings. Tau-U analysis showed a significant increase in memory performance between baseline and intervention phase (Tau-U = 1, 0.94, p < .01). A third participant withdrew from the intervention phase following difficulties turning off the reminders and frustrations with the reminder alert sound. For two of the three participants, use of MindMate was feasible and effective in supporting remembering of everyday tasks compared to practice as usual.

Mobile Health for Traumatic Brain Injury: A Systematic Review of the Literature and Mobile Application Market

Traumatic Brain Injury (TBI) is a growing public health issue with an increasing burden of disease globally. TBI can lead to significant motor, cognitive and emotional deficits. Mobile health (mHealth) is a promising technology to help diagnose and manage patients with TBI. The aim of this study was to systematically examine and classify available TBI mobile applications (apps) and critically appraise the literature underpinning mHealth for the management of TBI. Two major app markets (Apple and Google Play) were systematically searched. Included apps were classified and had data extracted. Coupled to this, a systematic search of the literature (MEDLINE, Web of Science, Scopus, PsycINFO) was performed examining the effectiveness of mHealth interventions in helping patients manage their symptoms after TBI (registered with PROSPERO: CRD42018107386). From 1296 apps, 53 met our inclusion criteria. The top three functions were TBI screening, education and biomechanics monitoring. Twenty-six apps (49.1%) focused on sports-related concussion. Eight apps (15.1%) were gamified and 12 apps (22.6%) connected to an external device. From the literature, a total of eight articles were included of which four (50%) were case series, two (25%) were feasibility/pilot studies, one (12.5%) was a case report, and one (12.5%) was a randomised controlled trial. The median number of patients was seven (1 - 43). There is a small number of mobile apps for TBI, mostly focusing on sports-related concussion. At present, the uptake and application of these apps as a management aid is limited and the evidence for their usefulness in TBI remains low.

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.

A review of prospective memory in individuals with acquired brain injury

OBJECTIVE

Prospective memory (PM) deficits have emerged as an important predictor of difficulty in daily life for individuals with acquired brain injury (BI). This review examines the variables that have been found to influence PM performance in this population. In addition, current methods of assessment are reviewed with a focus on clinical measures. Finally, cognitive rehabilitation therapies are reviewed, including compensatory, restorative and metacognitive approaches.

METHOD

Preferred reporting items for systematic reviews and meta-analyses guidelines were used to identify studies. Studies were added that were identified from the reference lists of these.

RESULTS

Research has begun to elucidate the contributing variables to PM deficits after BI, such as attention, executive function and retrospective memory components. Imaging studies have identified prefrontal deficits, especially in the region of BA10 as contributing to these deficits. There are now several clinical measures available with good psychometric properties. Rehabilitation techniques have mostly focused on compensatory strategies, but, in addition, some restorative and metacognitive approaches have shown preliminary promise.

CONCLUSIONS

PM deficits are a common and important deficit after BI. Clinical evaluation is recommended and further understanding of rehabilitation techniques is needed.

Google Calendar Enhances Prospective Memory in Alzheimer's Disease: A Case Report

We investigated whether an external memory aid (i.e., Google Calendar) would alleviate prospective memory compromise in a patient with mild Alzheimer's disease. The patient was asked in the baseline phase to perform three prospective targeted events (e.g., attending her weekly bridge game at the community club) and three prospective control events (e.g., buying her weekly magazine). The same six prospective events were assessed in the intervention phase but the targeted-events were cued by Google Calendar while the control-events were not. Results showed less omission of the targeted events in the training phase than in the baseline phase, suggesting a positive effect of Google Calendar. This case report offers a unique view into how smartphone calendars may alleviate prospective memory compromise in patients with mild Alzheimer's disease.

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.

Single-case experimental designs to assess intervention effectiveness in rehabilitation: A practical guide

Single-case experimental designs (SCED) are experimental designs aiming at testing the effect of an intervention using a small number of patients (typically one to three), using repeated measurements, sequential (±randomized) introduction of an intervention and method-specific data analysis, including visual analysis and specific statistics. The aim of this paper is to familiarise professionals working in different fields of rehabilitation with SCEDs and provide practical advice on how to design and implement a SCED in clinical rehabilitation practice. Research questions suitable for SCEDs and the different types of SCEDs (e.g., alternating treatment designs, introduction/withdrawal designs and multiple baseline designs) are reviewed. Practical steps in preparing a SCED design are outlined. Examples from different rehabilitation domains are provided throughout the paper. Challenging issues such as the choice of the repeated measure, assessment of generalisation, randomization, procedural fidelity, replication and generalizability of findings are discussed. Simple rules and resources for data analysis are presented. The utility of SCEDs in physical and rehabilitation medicine (PRM) are discussed.

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.