Patients can engage with technology during rehabilitation when prescription is tailored by a therapist. Perceiving benefit from using technology, in addition to receiving the right support to enable use appears to influence the level of patient engagement.
Therapists perceive many benefits to using feedback-based technologies in rehabilitation but view it as an addition rather than an alternative to usual therapy. Input from therapists was perceived to be needed for technology to achieve therapeutic benefit. Technology use in practice may be influenced by design limitations or the available support to access and use the technology. Implications for Rehabilitation Therapists perceive technology can be used for benefit as an adjunct to usual therapy with the skilled input of a therapist to assess and monitor patient performance to ensure the "right" quality and quantity of movements for recovery. Technology prescription requires an investment of time and a tailored approach so that its use meets the needs of the individual patient. Support for training, evidence of effectiveness and access to technology is imperative for implementation in practice. Therapists need to work collaboratively with technology developers to improve the design and usability of technologies to better support the rehabilitation process.
SynopsisSummary of Lampit, A., Hallock, H. & Valenzuela, M. (2014). Computerized cognitive training in cognitively healthy older adults: A systematic review and metaanalysis of effect modifiers. PloSMed, 11.Objectives of the review: To evaluate the efficacy of computerised cognitive training (CCT) on a number of cognitive outcomes in healthy older adults. To identify characteristics of the intervention associated with a positive effect on cognitive outcomes. Search strategies: Searches were conducted in Medline, Embase and PsycINFO for studies in all languages indexed on the databases before July 2014. The authors searched the reference lists of previous reviews. Selection criteria: The review included published randomised controlled trials investigating the effects of CCT on one or more cognitive outcomes. Studies were eligible if the mean age of participants was ≥ 60 years. Studies were excluded if the participants had major cognitive, neurological, psychiatric or sensory impairments. Trials included ≥ 4 hours of practice on computerised tasks or video games on computers, mobile phones or gaming consoles versus an alternative intervention or no intervention. The review analysed change in cognitive test outcomes immediately after training, and only included tests that were not specifically part of the training regime. Outcomes including quality of life and activities of daily living were excluded. Methods of the review: Two authors independently reviewed titles, abstracts and full-text papers. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool and the PEDro scale by two people independently. Data were combined in a meta-analysis where appropriate. Results: 52 studies (involving 4885 participants) were included in the review. The average PEDro score was 6.2/ 9. Intervention approach varied: 24 studies used multidomain training, nine used SOP training, nine used WM training, six used attention training and four were video games. Approximately 60% of studies involved group training and 37% involved home-based training. After removal of one outlier study the overall effect of CCT on cognition was small but statistically significant (g = 0.22, 95% CI 0.15-0.29, I2 = 29.9%). Meta-analyses of domain specific outcomes showed statistically significant effects in favour of CCT for verbal memory (g = 0.08) nonverbal memory (g = 0.24), working memory (g = 0.22), processing speed (g = 0.31) and visuospatial skills (g = 0.22). Meta-analysis of executive function and attention outcomes revealed no statistically significant difference between groups. Subgroup analysis showed that group based training was more effective than home based training and that completing 1-3 sessions per week was more effective than completing more than three sessions per week. Authors' conclusions: This systematic review shows that the overall effect of CCT on cognition is positive but small and that it is ineffective for executive functions and attention. Training parameters (e.g., setting, dose) are important and impact on...
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