Brain-In-Hand technology for adults with acquired brain injury: A convergence of mixed methods findings

Abstract

Introduction Individuals with acquired brain injury may find it difficult to self-manage and live independently. Brain-in-Hand is a smartphone app designed to support psychological problems and encourage behaviour change, comprised of a structured diary, reminders, agreed solutions, and traffic light monitoring system. Aim To evaluate the potential use and effectiveness of Brain-in-Hand for self-management in adults with acquired brain injury. Methods A-B mixed-methods case-study design. Individuals with acquired brain injury ( n = 10) received Brain-in-Hand for up to 12 months. Measures of mood, independence, quality of life, cognition, fatigue, goal attainment, participation administered at baseline, 6 and 12 months. Semi-structured interviews conducted with acquired brain injury participants ( n = 9) and healthcare workers ( n = 3) at 6 months. Results Significant increase in goal attainment after 6 months use (t(7) = 4.20, p = .004). No significant improvement in other outcomes. Qualitative data suggested improvement in anxiety management. Contextual (personal/environmental) factors were key in influencing the use and effectiveness of Brain-in-Hand. Having sufficient insight, appropriate support and motivation facilitated use. Conclusions Brain-in-Hand shows potential to support acquired brain injury, but further work is required to determine its effectiveness. Context played a pivotal role in the effectiveness and sustained use of Brain-in-Hand, and needs to be explored to support implementation.

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

“…However, ten interventions targeted challenging behaviours that could not be readily categorised using the OBS. 56,58,[60][61][62][63][64][65][66]70 These addressed emotional dysregulation and psychological distress (e.g., stress, anxiety, or depression). These studies also frequently integrated measures of other challenging behaviours, such as verbal/physical aggression, 58,[61][62][63] but also lack of initiation and inappropriate social behaviours.…”

“…This was further investigated in a consecutive study (e.g., family member, partner or carer). 70 Stakeholders who provided the intervention. All mobile applications were intended to be ultimately used independently by participants with an ABI with no input from health care professionals, 60,61,63,64,70 except when specified otherwise (e.g., training, interviews, home visits; 61,63,64,70 ).…”

“…62 Finally, trainers' professional background was specified only in Kim, Wemon's (PhD candidate trained in neuropsychological assessments and HRV biofeedback) 65,66 and Kettlewell, Ward studie (PhD student trained to use Brain in Hand). 70 What are the specific context(s) of use and feedback modalities of the technology?…”

“…Mobile applicationsbased interventions were either offered in living environments, 60,61 clinical environments, 64 or both depending on the participant's choice. 70 All neurofeedback, biofeedback, or virtual reality interventions were implemented in clinical settings. [56][57][58]62,65,66 In addition to clinic-based interventions, the biofeedback intervention of Kim, Wemon's 65,66 also provided handheld devices to be used at home for further practice.…”

“…FASTER: Phase of intervention development. As described in Table 1, three studies were situated in Phase 1 (i.e., development and documentation 38,67,68 ) and 11 studies were in Phase 2 (i.e., feasibility 56,[57][58][59][62][63][64][65][66]70 ). Overall, only two studies were in Phase 3 (i.e., implementation and effectiveness 60,61 ).…”