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

Abstract

Purpose: To investigate how individualized occupation-based interventions with commonly available everyday technology (ET) can compensate for perceived difficulties with daily life tasks after an aquired brain injury (ABI) and improve satisfaction with occupational performance. Method: This intervention study was designed as a multiple case study according to Yin. Ten men and women with an ABI (traumatic or non-traumatic) participated. Data were collected through interviews, observations and field notes before and after the intervention and at follow-up (on average 11 weeks afterwards). The interventions focused on enabling each participant's prioritized goals related to task performance in daily life. Results: All participants achieved all their goals by learning to use both new functions in their own familiar ET and new ET. The participants perceived difficulties in occupational performance decreased and their satisfaction with occupational performance increased with the use of ET. Conclusions: An individualised intervention process, involving the use of own familiar ET or ET off-the-shelf, has the potential to compensate for perceived difficulties following an ABI and improve satisfaction with occupational performance in daily life.Key words: activities of daily living; assistive technology; brain injury; occupational therapy; rehabilitation INTRODUCTIONPeople with an acquired brain injury (ABI) can experience a wide range of difficulties with daily life tasks, such as self-care, productivity and leisure [1,2], as well as restrictions of participation and decreased quality of life [3][4][5][6][7]. A compensatory approach to reduce remaining disabilities are therefore commonly applied, in rehabilitation in general [4,8,9] as well in occupational therapy [10,11]. In occupational therapy [11], adapted methods of doing, adaptive equipment and assistive technology (AT) are used to compensate for ineffective actions to improve the performance of daily life tasks that people with an ABI need and want to do to enhance their roles and participation in society.AT comprises low-tech (mechanical) and high-tech (electro-mechanical or computerized) devices [12] and is defind as "any item, piece of equipment, or product system, (acquired commercially off-the-shelf, modified, or customized), that is used to increase, maintain, or improve functional capabilities of individuals with disabilities" [13]. However, it can be difficult to differentiate AT from everyday technology (ET) objects [14], such as mobile phones and computers, that already exist in peoples' lives and may be used to reduce difficulties in occupational performance.In reviewing the literature about the use and efficency of AT or ET in the form of electronic aids in people with ABI, it was found that a variety of AT, such as palmtop computer, paging system, voice organizer, can reduce memory problems [9,[15][16][17][18][19]. To the best of our knowledge, only one study has used unmodified handheld computers off-the-shelf to compensate for disabilities ...

Facilitators for travelling with local public transport among people with mild cognitive limitations after stroke

“…Yet, there is reason to believe that new technology will be used more frequently also among the older population in the future. Previous studies have shown that everyday technology, e.g., mobile phones and gps, can be used to improve performance in different daily activities [36]. Such equipment is also developed by public transport authorities with the aim to facilitate travel information asked for.…”

Computer-based assistive technology and changes in daily living after stroke

“…As an example, the risk of decreased awareness of the disability also reduces the persons' ability to perform everyday activities and decreases their safety both for people with dementia (Öhman, Nygård & Kottorp, 2011) and people with stroke (Ekstam, Uppgard, Kottorp & Tham, 2007;Hartman-Maeir et al, 2003). Previous research has shown that persons in both groups can perceive difficulties in planning time (Lindén, Lexell & Larsson Lund, 2011;Nygård & Johansson, 2001), and further, how they experience lack of control and structure, reduced independence and changed social roles (Carlsson, Möller & Blomstrand, 2004;Holst & Hallberg, 2003;Steeman et al, 2005). These changed social roles affect interpersonal relationships, responsibilities (Häggström et al, 2008;Steeman et al, 2005;Viscogliosi et al, 2010) and participation in community life (Viscogliosi et al, 2010).…”

“…When mainstream technology such as smartphones and computers has become so easy to modify to the individual user, they have become a very good support for people with cognitive impairments in e.g. structuring the day or being reminded (Lindén, Lexell & Larsson Lund, 2011). It has also become possible to combine standard smartphones and computers with software specially designed for persons with cognitive impairment, providing support in, e.g., surfing or e-mailing, paying in shops or having control of expenses and other payments (Hjälpmedelsinstitutet, n.d.).…”

“…This can be illustrated by how a person who has difficulties with time orientation is assumed to need an electronic calendar even if the person's goals and desires are not known or have not yet been identified. This limited attention in research to the person's own desires and goals has been acknowledged (Topo, 2009) and questioned previously, for example since the way of providing the AT is neither in line with current knowledge of brain injury rehabilitation research (Lindén et al, 2011), nor is it supported by the occupational therapy guidelines related to client centeredness (Lindén et al, 2011).…”

Experienced usability of assistive technology for cognitive support with respect to user goals

“…There is a risk that even if the AT is useful for the user, it might not be used since it does not have a sufficiently positive influence on the user's life (Hersch, 2010). There are studies, evaluating cognitive support, both in terms of AT and in terms of support from off-the-shelf technology, that report to what extent the users' individual goals have been achieved as an outcome measure (Wade & Troy, 2001;Boman et al, 2010;Lindén, Lexell & Larsson Lund, 2011), but they are rare. Instead, there are factors such as, e.g., the considered usefulness of function of the AT Meiland et al, 2012), experienced usefulness (Topo et al, 2007), satisfaction of function, experienced autonomy, quality of life (Meiland et al, 2012), completion of the targeted task (Oriani, et al, 2003;Lancioini et al, 2010), and, finally, benefits (Topo et al, 2007;Lindqvist, Nygård, & Borell, 2013) and experiences when using the AT (Topo, Jyllhä & Laine, 2002;Lindqvist & Borell, 2012) have been evaluated.…”