Improvements of task performance in daily life after acquired brain injury using commonly available everyday technology

Usability of a touchscreen assessment tool (TATOO) prototype for clinicians and typically developing children

PURPOSE

Touchscreen devices are widely used in modern life and have quickly become part of daily life for children, including during Occupational Therapy sessions for children with disabilities. Touchscreen Assessment Tool (TATOO) is a prototype application used to evaluate children's performance when using touchscreen devices. The purpose of this study, based on the logical user-centred interaction design framework, was to evaluate TATOO's usability for occupational therapists and typically developing children and to examine the correlations between their usability scores.

METHODS

A convenience sample of clinicians (N = 10) and children with typical development (N = 60) was recruited for this study. The usability assessment was conducted using the System Usability Scale (SUS) and semi-structured interviews for the clinicians, and the Short Feedback Questionnaire-Child (SFQ-Child) for the children.

RESULTS

The SUS scores (M ± SD = 85.5 ± 8.04, range = 70-97.5) indicated good ratings of TATOO's usability by clinicians; the SFQ-Child results showed children also rated its usability very highly, including all ages (4-10 years) and all tasks. The clinicians all expressed positive attitudes towards using TATOO, and no bias was found between the clinicians' usability scores and the children's usability feedback.

CONCLUSION

The TATOO is a user-friendly tool. Researchers and clinicians can benefit from the availability of an objective and low-cost assessment tool to promote their evaluation and intervention by providing more focussed individualized recommendations and adaptations. The study also suggests a model to follow when developing applications and evaluating their usability through a mixed-method approach to deepen understanding of the user's needs.Implications for rehabilitationTouchscreen Assessment Tool (TATOO) shows a user-friendly tool for assessing the different skills required to operate touchscreens interface.TATOO has the potential to become an essential objective and low-cost assessment tool for the clinician, in which the spread of touchscreens constantly increases.Researchers and clinicians can benefit from the availability of such tools to promote their evaluation and intervention by providing more focussed individualized recommendations and adaptations.TATOO will complement the assessment needs, as traditional fine motor assessment tools cannot capture the skills necessary to operate a touchscreen deviceThe study suggests a model to follow when developing applications and evaluating their usability through a mixed-method approach in order to deepen understanding of the user's needs.

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.

Motivators and barriers to using information and communication technology in everyday life following stroke: a qualitative and video observation study

Purpose: Information and communication technology devices have become a ubiquitous part of everyday life and a primary means of communication. The aim of this study was to describe the experience of information and communication technology and to explore the barriers and motivators to its use following stroke.Materials and methods: This observational study used semi-structured individual interviews and video observation of information and communication technology device use with six people, four men, and two women age 60-82 years with upper limb disability following stroke. They were analyzed using thematic analysis.Results: Three themes were identified that relate to barriers: (i) Sensory and motor impairments; (ii) Limited vision and impaired speech; and (iii) Device-specific limitations. Six themes were identified as motivators: (i) Connect with others; (ii) Provide safety; (iii) Facilitate reintegration; (iv) Reinforce technology adoption; (v) Leisure activities; and (vi) Contribute to the rehabilitation process.Conclusion: All participants used some form of information and communication technology daily to promote safety, enable daily activities, and social interaction, and to a lesser extent engage in leisure and rehabilitation activities. Barriers to information and communication technology use were primarily related to stroke related impairments and device-specific requirements, which limited use, particularly of smartphones. These barriers should be addressed to facilitate the use of information and communication technology devices.Implications for rehabilitationThis research suggests that;People with stroke are highly motivated to use information and communication technology devices in daily activitiesStroke-specific and age-related impairments limit the use and functionality of information and communication technology devices for people with strokeInformation and communication technology devices do not appear to be promoted or used in the rehabilitation or as assistive technologies.

The contrasting role of technology as both supportive and hindering in the everyday lives of people with mild cognitive deficits: a focus group study

BACKGROUND

It is well known that people with mild cognitive deficits face challenges when performing complex everyday activities, and that the use of technology has become increasingly interwoven with everyday activities. However, less is known of how technology might be involved, either as a support or hindrance, in different areas of everyday life and of the environments where challenges appear. The aim of this study was to investigate the areas of concern where persons with cognitive deficits meet challenges in everyday life, in what environments these challenges appear and how technology might be involved as part of the challenge and/or the solution to the challenge.

METHODS

Data were gathered through four focus group interviews with participants that live with cognitive deficits or cohabit with a person with cognitive deficits, plus health professionals and researchers in the field. Data were transcribed, coded and categorized, and finally synthesized to trace out the involvement of technology.

RESULTS

Five areas of concern in everyday life were identified as offering challenges to persons with cognitive deficits: A) Managing personal finances, B) Getting around, C) Meeting family and friends, D) Engaging with culture and media and, E) Doing everyday chores. Findings showed that the involvement of technology in everyday activities was often contrastive. It could be hindering and evoke stress, or it could bring about feelings of control; that is, being a part of the solution. The involvement of technology was especially obvious in challenges linked to Managing personal finances, which is a crucial necessity in many everyday activities. In contrast, technology was least obviously involved in the area Socializing with family and friends.

CONCLUSIONS

The findings imply that technology used for orientation and managing finances, often used outside home, would benefit from being further developed in order to be more supportive; i.e. accessible and usable. To make a positive change for many people, the ideas of inclusive design fit well for this purpose and would contribute to an age-friendly society.

BUS TRIPS-A Self-Management Program for People with Cognitive Impairments after Stroke

Stroke is a major cause of disability worldwide and different types of impairments can affect the individual’s ability to manage everyday activities such as travel that is essential for participation in society. The purpose of this study was to investigate the feasibility of a new self-management intervention (BUS TRIPS) focusing on travelling by bus, and potential contributions to an improved ability to travel by bus for people with cognitive impairments after stroke. This is a pilot study of five individuals, utilizing a multiple case study design with a mixed methods approach. Assessments (Stroke Impact Scale, General Self-Efficacy Scale and Life Satisfaction Scale-11, Item 1) were performed before, two weeks after, and three months after the program. The data collection also comprised reflection notes from the group leaders (an occupational therapist and a physiotherapist), a semi-structured group interview and an individual phone survey. The feasibility of the intervention was presented in four sub-categories: (1) appreciated group format despite too short sessions; (2) the importance of skilled leaders and motivated participants; (3) session material adequate but needs minor revision to fit the target group; and (4) homework is valuable but reflective group discussions must be supported. The narratives of each case showed that all participants made some progress related to travelling by bus, but the overall positive results could not be verified by all of the quantitative assessments. We conclude that the BUS TRIPS intervention is feasible and can potentially contribute to an improved ability to travel by bus for the target group. Future studies is called for, and should focus on recruitment challenges, to clarify assessments that would be suitable to use in larger scale clinical trials and during subsequent implementation in clinical practice.

A multidisciplinary approach for developing an assessment tool for touch screen devices

AIM

The aim of this study was to describe the processes of reaching consensus regarding the assessment of the user's skills required to operate various touch screen devices. A five-step procedure was used to collect and validate the required skills by a multidisciplinary team of 52 experts. Content validity was calculated to determine the agreement levels between the experts. A comparison was made between the discipline groups in order to test correlation between each group and their choice of specific clusters of tasks.

METHODS

The final consensus set by the experts' recommendations included 15 domains and 50 skills/measurements. The result of Cronbach's α test for the final assessment questionnaire (50 skills/measurements) was 0.94, which indicates a high degree of internal consistency. The results of Kruskal-Wallis's test showed the lack of any significant difference between agreements of the clinicians and the technicians groups, but significant differences were found between the educators and the clinicians groups.

CONCLUSION

The assessment questionnaire, in its current form, can be used by clinicians and it is expected to help in developing an objective assessment tool to quantify the performance and touch characteristics of individuals with varying abilities and disabilities, in order to enhance accessibility of touch screen technology. Implications for Rehabilitation Collecting and creating the required knowledge needed for assessing the user's skills for operating touch screen devices. The created knowledge helps clinicians to focus on the essential skills and measurements needed for a comprehensive assessment of the individual's abilities and disabilities while operating touch screen devices. The results of the assessment can be used as recommendations for enhancing accessibility of touch screen devices for various disabilities. This knowledge is expected to help in developing an application that provides an objective assessment tool. The study emphasizes the importance of close collaboration with multidisciplinary teams for creating a valid assessment tool.

Occupations outside the home: Experiences of people with acquired brain injury

Introduction

Understanding those occupations outside the home that people with acquired brain injury find difficult, including the influencing factors, may help to develop appropriate support. The aim of this paper was to explore and describe how people with acquired brain injury experience engagement in occupations outside the home.

Method

This qualitative study included repeated semi-structured interviews with eight working-age persons with acquired brain injury, which were analysed by a constant comparison analysis.

Findings

The findings indicated that there were three influencing factors that had a critical effect on the participants’ changes in their engagement in occupations, the strategies they adopted, and the consequences for their lives. The categories reflected how the different changes in occupations outside the home were influenced by their struggles with sensory processing and fatigue, difficulties with completing preparations, and occupational risks.

Conclusion

The findings indicate that to improve engagement in occupations outside the home for people with acquired brain injury, professionals need to identify the different factors that are critical for each person’s engagement. The findings also indicate the importance of considering not only occupations outside the home but also preparations required at home and recovery afterward, and how engagement outside the home is influenced by the entire occupational repertoire.

Assistive technology to promote occupation and reduce mouthing by three boys with fragile X syndrome

OBJECTIVES

To extend the use of assistive technology (AT) for promoting a new adaptive response and to reduce hand mouthing, by three boys with fragile X syndrome. To monitor the effects of the intervention program on the positive mood. To carry out a three month follow-up phases. To conduct a social validation assessment involving 30 parents of children who presented multiple disabilities as raters.

METHODS

The study was implemented according to an ABAB experimental design, where A represented baseline phases (technology available but inactive) and B represented intervention phases (the technology ensured 7 s of positive stimulation).

RESULTS

All participants improved and consolidated their performance. Parents involved in the social validation assessment rated positively the use of such technology.

CONCLUSION

AT-based program was useful, affordable, and effective for enhancing constructive engagement, self-determination, and for improving quality of life by children with fragile X syndrome and severe to profound developmental disabilities.

Electronic assistive technology used by people with acquired brain injury in shared supported accommodation: Implications for occupational therapy

Introduction

People with severe acquired brain injury often require lifetime support, sometimes received from paid workers if living in shared supported accommodation. Electronic assistive technology may offer a less intrusive method of support that can enable autonomous participation and deliver cost savings. However, research on rates, barriers, and facilitators of electronic assistive technology uptake is lacking. This study aimed to identify electronic assistive technology types used by people with acquired brain injury living in shared supported accommodation, assess user satisfaction and psychosocial impact of electronic assistive technology, detail the impact of technology use on respondents’ participation and support needs, and describe barriers and/or facilitators to electronic assistive technology uptake and ongoing use.

Method

Participants were identified electronic assistive technology users with acquired brain injury living in shared supported accommodation in Australia ( N = 22). Mixed methods data were collected using semi-structured interviews and published measures of support need, electronic assistive technology satisfaction, and psychosocial impact.

Results

Participants reported satisfaction with the devices they used, and positive psychosocial outcomes. Areas impacted by electronic assistive technology, key facilitators and barriers to electronic assistive technology use, and implications for occupational therapists working to deliver electronic assistive technology solutions were identified.

Conclusion

Electronic assistive technology use by this group can positively influence both everyday functioning and participation. Skilled prescription and ongoing support services are necessary to maximise uptake and use.

Interventions aimed at improving the ability to use everyday technology in work after brain injury

OBJECTIVE

The aim of this study was to explore and describe how client-centred occupational therapy interventions may support and improve the ability to use everyday technology (ET) in work tasks in people with acquired brain injury (ABI).

METHOD

A qualitative, descriptive multiple-case study was designed, and occupation-based interventions were provided to three working-age participants with ABI. Multiple sources were used to collect data throughout the three intervention processes, including assessments, field notes, and interviews. The Canadian Occupational Performance Measure and the Management of Everyday Technology Assessment were administered before the interventions, after the interventions and at a follow-up session 2-3 months subsequent to the interventions.

RESULTS

The three intervention processes initially consisted of similar actions, but subsequently the actions took on a different focus and intensity for each case. All of the goals in each of the three case processes were achieved, and both perceived and observed abilities to use ET in work tasks improved.

CONCLUSIONS

Client-centred occupational therapy interventions might have the potential to improve the ability to use ET in work tasks in people with ABI.