Facilitators and obstacles to the use of a cognitive orthosis for meal preparation within the homes of adults with a moderate to severe traumatic brain injury: Informal caregivers and health-care professionals’ perspectives

Assistive technology in brain injury rehabilitation: A survey scoping clinician frequency and type of assistive technology use

ABSTRACTThe benefits of assistive technology (AT) have been well established to positively support participation within disability. Clinicians have an important role in guiding clients to choose goal-centred AT. This study aims to explore (i) the frequency and types of AT prescribed by clinicians and (ii) real-world implementation of AT by clinicians, employing the ISO 9999 framework, and the challenges involved with AT prescription. An online survey was circulated to brain injury clinicians within New South Wales (NSW). Data were exported into IBM SPSS Statistics v.27 for analysis. Free text responses were analysed using a mixed-methods content analysis. A total of 31 AT products were reported 131 times by clinicians. The most frequently reported AT category was mainstream technology (n = 81), used amongst all professions. Using the ISO 9999 framework, the most reported class use of AT was "communication and information management" (n = 77/131). Challenges around AT implementation were funding acquisition, customizability of AT and time constraints with training. NSW clinicians have demonstrated varied use of AT to support cognitive, physical and communication functions. However, with the rapidly advancing nature of AT, there needs to be quicker approaches to generate high-quality evidence to support its use.

A Scoping Review of Implementation Science Studies in the Field of Traumatic Brain Injury: State of the Science and Future Directions

OBJECTIVE

Implementation research is essential to accelerating the public health benefits of innovations in health settings. However, the US National Academies of Sciences, Engineering, and Medicine 2022 report identified a lag in published implementation research applied to traumatic brain injury (TBI). Our objectives were to characterize implementation science studies published to date in TBI clinical care and rehabilitation and provide recommendations for future directions.

METHODS

A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Articles published between 2011 and 2023 were identified (MEDLINE, PubMed, PsychInfo, and Web of Science), and included if the study focused on the TBI population, measured at least one Proctor (2011) implementation outcome and aligned with implementation research designs. Data were charted using an extraction template.

RESULTS

Of the 38 articles, 76% were published between 2018 and 2023. About 37% of articles were in the pre-implementation phase, and 57.9% were in the implementation phase. Over half of articles used a theory, model, or framework to guide the research. Fifteen studies were descriptive, 10 were qualitative, 7 were mixed methods, and 4 were randomized controlled trials. Most studies investigated implementation outcomes regarding national guidelines following TBI or TBI symptom management. Adoption (42.1%) and fidelity (42.1%) were the most commonly studied implementation outcomes, followed by feasibility (18.4%), acceptability (13.2%), and penetration (10.5%). Only 55% of studies used or tested the effectiveness of one or more implementation strategies, with training and education used most commonly, followed by data warehousing techniques.

CONCLUSIONS

Future research should prioritize the selection and investigation of implementation strategy effectiveness and mechanisms across contexts of care and use implementation research reporting standards to improve study rigor. Additionally, collaborative efforts between researchers, community partners, individuals with TBI, and their care partners could improve the equitable translation of innovations across service contexts.

COOK technology to support meal preparation following a severe traumatic brain injury: a usability mixed-methods single-case study in a real-world environment

INTRODUCTION

Following a traumatic brain injury (TBI), meal preparation may become challenging as it involves multiple cognitive abilities and sub-tasks. To support this population, the Cognitive Orthosis for coOKing (COOK) was developed in partnership with an alternative residential resource for people with severe TBI. However, little is known about the usability of this technology to support people with TBI living in their own homes.

METHODS

A usability study was conducted using a mixed-methods single-case design with a 35-year-old man with severe TBI living alone at home. The number of assistances provided, time taken and the percentage of unnecessary actions during a meal preparation task were documented nine times to explore the usability of COOK. Interviews were also conducted with the participant to document his satisfaction with COOK. Potential benefits were explored via the number of meals prepared per week.

RESULTS

The usability of COOK was shown to be promising as the technology helped the participant prepare complex meals, while also reducing the number of assistances needed and the percentage of unnecessary actions. However, several technical issues and contextual factors influenced the efficiency and the participant's satisfaction with COOK. Despite improving his self-confidence, COOK did not help the participant prepare more meals over time.

CONCLUSION

This study showed that COOK was easy to use and promising, despite technical and configuration issues. Results suggest the importance of further technological developments to improve COOK's usability and fit with the needs of people with TBI living in their own homes.

Implementation of an assistive technology for meal preparation within a supported residence for adults with acquired brain injury: a mixed-methods single case study

OBJECTIVES

This study aimed to investigate the feasibility of implementing an assistive technology for meal preparation called COOK within a supported community residence for a person with an acquired brain injury.

METHODS

Using a mixed-methods approach, a multiple baseline single-case experimental design and a descriptive qualitative study were conducted. The participant was a 47-year-old woman with cognitive impairments following a severe stroke. She received 21 sessions of training on using COOK within a shared kitchen space. During meal preparation, independence and safety were evaluated using three target behaviours: required assistance, task performance errors, and appropriate responses to safety issues, which were compared with an untrained control task, making a budget. Benefits, barriers, and facilitators were assessed via three individual interviews with the client and three focus groups with the care team.

RESULTS

Both quantitative and qualitative analyses showed that COOK significantly increased independence and safety during meal preparation but not in the control task. Stakeholders suggested that the availability of a training toolkit to a greater number of therapists at the residence and installation of COOK within the client's apartment would help with successful adoption of this technology.

CONCLUSION

COOK is a promising assistive technology for individuals with cognitive deficits who live in supported community residences.Implication For RehabilitationCOOK is a promising assistive technology for cognition to increase independence and safety in meal preparation for clients with ABI within their supported living contexts.Receiving training from an expert and the availability of technical support are imperative to the successful adoption of COOK.

Clinician experiences with using assistive technology in brain injury rehabilitation: a survey of clinician capability, attitudes, and barriers

BACKGROUND

The rise in assistive technology (AT) solutions to support people with an acquired brain injury (ABI) has warranted clinicians to build capability in assisting clients to select goal-centred AT. The study explored, amongst ABI clinicians, (a) capability, attitudes, and barriers with AT implementation, (b) age-related differences in technology self-efficacy and capability (c) strategies to support AT use in rehabilitation and (d) thematic analysis of AT-related experiences.

METHOD

Mixed methods design. Online survey circulated to ABI clinicians across New South Wales, Australia, comprising purpose-designed items as well as the Modified Computer Self-Efficacy Scale (MCSES; range 0-100).

RESULTS

Clinicians (n = 123) were evenly distributed across decadal age groups. The majority were female (90%, n = 111) and one-third were occupational therapists.Clinicians scored strongly on the MCSES (Mdn = 76, IQR = 19), with younger age groups significantly associated with higher scores (H[3] = 9.667, p = .022). Most clinicians (92%) were knowledgeable of mainstream technology for personal use, but over half (65%) reported insufficient knowledge of suitable AT for clients. Clinicians reported positive attitudes towards AT, however, time to research and develop proficiency with a range of AT was the primary barrier (81%).Thematic analysis suggested that whilst the ideal AT experience is client-motivated requiring multidisciplinary guidance, the clinician role and experience with AT is evolving, influenced by rapid technological advancement and extrinsic opportunities to access AT.

CONCLUSIONS

Whilst clinicians have positive attitudes towards AT, there is a gap in clinician implementation. There is need to support further resources to build clinician capability and access to AT.

Development of an Assistive Technology for Cognition to Support Meal Preparation in Severe Traumatic Brain Injury: User-Centered Design Study

Background

Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population.

Objective

This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users’ profiles and establishing the clinical requirements of the ATC.

Methods

In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework.

Results

The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task.

Conclusions

This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability.

Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study

Background

User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments.

Objective

The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology.

Methods

This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability.

Results

Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences).

Conclusions

By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology.

Technology options to help people with dementia or acquired cognitive impairment perform multistep daily tasks: a scoping review

Purpose

The purpose of this paper is to review studies that evaluated technology-based prompting systems for supporting participants with dementia or acquired cognitive impairment in their performance of multistep daily tasks.

Design/methodology/approach

A scoping review was conducted to identify eligible studies through a search of four electronic databases, that is, PubMed, PsycINFO, Web of Science and Institute of Electrical and Electronics Engineers.

Findings

The search, which covered the 2010–2020 period, led to the identification of 1,311 articles, 30 of which were included in the review. These articles evaluated six different types of prompting systems: context-aware, automatic computer prompting, context-aware, mediated computer prompting, teleoperated robot prompting, self-operated augmented reality prompting, self-operated computer or tablet prompting and time-based (preset) computer, tablet or smartphone prompting.

Originality/value

Technology-aided prompting to help people with dementia or acquired cognitive impairment perform relevant multistep daily tasks is considered increasingly important. This review provides a picture of the different prompting options available and of their level of readiness for application in daily contexts.

Potential advantages, barriers, and facilitators of implementing a cognitive orthosis for cooking for individuals with traumatic brain injury: the healthcare providers' perspective

PURPOSE

Considering the key role of health care providers in integrating assistive technologies into clinical settings (e.g., in/outpatient rehabilitation) and home, this study explored the care providers' perspectives on benefits, barriers and facilitators to the implementation of the Cognitive Orthosis for coOking (COOK) for adults with traumatic brain injury (TBI) within clinical contexts and homes.

METHODS

Using a qualitative descriptive approach, semi-structured individual interviews and focus groups were carried out with experienced care providers of adults with TBI (n = 30) in Ontario-Canada. Qualitative analysis based on the Miles et al approach was used.

RESULTS

According to the participants, COOK could potentially be used with individuals with cognitive impairments (TBI and non-TBI) to increase safety and independence in meal preparation and support healthcare providers. However, limited access to funding, clients' lack of motivation/knowledge, and the severity of their cognitive and motor impairments were perceived as potential barriers. Facilitators to the use of COOK include training sessions, availability of private/provincial financing, and comprehensive assessments by a clinical team prior to use.

CONCLUSIONS

Health care providers' perspectives will help develop implementation strategies to facilitate the adoption of COOK within homes and clinical contexts for individuals with TBI and improve the next version of this technology.IMPLICATIONS FOR REHABILITATIONCOOK shows a high potential for increasing independence and safety during meal preparation with its sensor-based monitoring of the environment and cognitive-based assistance, for adults with TBI.Comprehensive clinical assessments to identify individuals' therapeutic goals, clinical characteristics, and living environments are necessary to facilitate the deployment of COOK.