An Evaluation of Driving Ability in a Simulator: A Good Predictor of Driving Ability After Stroke?

The aim of this pilot-study was to evaluate the predictive quality of adriving evaluation in a simulator for people with stroke. Twenty-seven participantswith stroke completed a driving evaluation in a technically advanced drivingsimulator. The participants also completed an on-road driving evaluation with a passor fail outcome. Measures generated from the assessment tool, P-Drive, werecompared to the on-road driving evaluation, in order to determine a definitive cut-offscore. The definitive cut-off score of P-Drive was determined to 1,5 logits, howeverthis score did not show satisfactory sensitivity. Instead of a definitive cut-off score, acut-off zone of 1,4 to 1,7 logits was recommended. Six drivers within the cut-offzone were recommended for further evaluation of their driving ability

Factors that impact the level of difficulty of everyday technology in a sample of older adults with and without cognitive impairment

Everyday technologies (ET) are an important part of the environment in which we live and interact, and older adults with cognitive impairments have to be able to manage ETs in order to participate in society. The aim of the present study was to bring new insight into what makes an ET easy or difficult to use for older adults with and without cognitive impairment. Older adults with or without cognitive impairments (n=116) were observed managing 27 ETs. In order to analyze and detect variables that influenced the level of difficulty of the ETs managed, a regression analysis was used and predefined assumptions were investigated. The results revealed that ETs that were used less than once a week were more difficult to handle, as were those with a complex design. The results suggests that ETs, more specifically Information and Communication Technology, need to be designed to be more user-friendly and less complex, and older adults that wish to continue using an ET need to be frequent users. The age and gender of the user, and how long the ET had been in use did not relate to how difficult an ET was to manage.Swedish Research Council, Swedish Brain Power, Botkyrka Community, The regional agreement on medical training and clinical research (ALF) between the Stockholm County Council and Karolinska Institutet, The American Alzheimer’s Association (Everyday Technologies for Alzheimer’s Care)Accepte

Design and management features of everyday technology that challenge older adults

Introduction: The management of everyday technologies could present too difficult a challenge for older adults with cognitive impairments, leading to their exclusion from participation. The present study aims to identify and describe features that make everyday technologies more or less difficult for older adults, whether with or without cognitive difficulties. Methods:A pre-existent, empirically generated hierarchy of more to less difficult everyday technologies was analysed. A mixed methods design was used to investigate predefined assumptions. Findings: Correlation analysis indicated that the more difficult everyday technologies required a higher frequency of skill actions; a positive correlation between the difficulty of an everyday technology and the need to perform actions in a logical sequence when using it was identified. The analysis indicated that feedback provided to users by less difficult everyday technologies consisted of different modes of stimuli (visual, auditory and tactile), while that from more difficult everyday technologies provided a high frequency of complex visual feedback. The less difficult everyday technologies were designed in a manner that was more intuitive; the design guided the user and fewer errors could be made. Conclusion: This study presents several features in the design of everyday technologies, and the skills required in using them, that could make their management more difficult for older adults.Swedish research councilSwedish Brain PowerBotkyrka CommunityThe American Alzheimer's AssociationALFAccepte

Changes in the technological landscape over time : everyday technologies relevance and difficulty levels as perceived by older adults with and without cognitive impairment.

BACKGROUND: Everyday technology, ET (e.g. computers, TV's and vending machines) perceived as relevant and used in everyday activities change continuously. Not being able to keep up with these changes may hinder participation in activities. OBJECTIVE: To investigate stability and change in perceived relevance of ET, and in levels of perceived ET difficulty across two different occasions in time and between two similar samples of older adults with and without cognitive impairment. METHODS: Data of perceived relevance and difficulty in ET use in the samples (n= 157/118), collected with the Everyday Technology Use Questionnaire (ETUQ) was investigated. RESULTS: Thirty-three (70%) of the ETs in the ETUQ significantly increased in relevance, while the perceived levels of difficulty were statistically similar in 40/47 ETs (85%) across the two time occasions. CONCLUSIONS: The perceived relevance of ET among older adults with and without cognitive impairment was indicated to increase over time, but the levels of perceived levels of difficulty of ETs did not change as much. This knowledge could be used to support and facilitate ET use in the aging population, and in general to influence society's view of older people as active users of ET in activities at home and in public spaces.Swedish Brain PowerThe Swedish Council for Working Life and Social Research (FAS)The Health Care Sciences Postgraduate School,The regional agreement on medical training and clinical research between the Stockholm County Council and the Karolinska InstitutetManuscrip

The development of the Karolinska Institutet Rapid Ease of Use Mapping (KIREUM) for technologies

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Driving ability among people with stroke : Developing assessments and exploring the livedexperience

The overall aim of this thesis was to explore and describe methods for assessing driving ability and awareness of driving disability following stroke, and to explore and describe the lived-experience of driving ability in the process of a driving evaluation. The thesis included four studies. In Study I people with stroke drove in a driving simulator and the focus was to investigate aspects of validity and stability of a newly developed assessment tool, PDrive, using Rasch statistics. In Study II people with stroke who had previously conducted a driving test in a driving simulator and had difficulties driving safely participated. The aim was to investigate awareness of driving disability. In Study III four men with stroke were interviewed during their driving evaluations. The aim was to explore and describe the lived-experience of driving ability in the context of being in the process of a driving evaluation using a phenomenological approach. In Study IV participants were people with stroke, dementia and mild cognitive impairments. The participants took an on-road driving test and the aim was to determine aspects of validity and reliability of P-Drive (on-road version), using Rasch statistics. In conclusion, the results of Studies I and IV indicated that P-Drive (two new versions) was an assessment tool that was valid and reliable for assessing driving ability in people with stroke in a driving simulator or on-road, respectively. Both versions of P-Drive demonstrated evidence of internal scale validity, person response validity and also acceptable levels of person separation reliability. In Study II lack of awareness of driving disability was evident since the majority of the drivers who failed the simulator test also had limited awareness of their disability. In Study III the participants experienced their driving ability as unaffected by the onset of stroke, and driving ability was taken for granted. Limited awareness of disability was indicated since participants were driving despite recommendations not to drive. The results (Study III) also increased our knowledge about the negative feelings that could be aroused by driving cessation and evaluation

Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app

Background: Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app. Objective: The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme. Methods: Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory. Results: Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be. Conclusions: An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.

Engaging occupations among persons at risk for stroke : A health paradox

Background: An occupational perspective in stroke prevention could support sustainable changes in habits and routines that could contribute to reduce modifiable risk factors. Aim: To explore engaging occupation in relation to risk for stroke by drawing on experiences from everyday life among persons with a heightened risk for stroke. Material and methods: Interviews from 14 persons with an increased risk for stroke were analysed by a constant comparative approach. Findings: The analysis resulted in the core category; the paradox of engaging occupations and health. The paradox involved aspects of engaging occupations that could provide well-being and at the same time were compromising considering stroke health. Conclusions and significance: The paradox conceptually challenges some of the core values inherent in occupational therapy regarding the relationship between engaging occupations, health and well-being. Gaining a deeper understanding of experiences of occupations and studying this in relation to health promoting or compromising characteristics of occupations, can facilitate lifestyle programs that support changes in everyday life. Moreover, programs need to be designed to offer personal relevance and to facilitate a positive balance between health compromising occupations and health promoting occupations in everyday life

Juggling the management of everyday life activities in persons living with chronic obstructive pulmonary disease

PURPOSE: Evidence regarding everyday life activities in people living with COPD is limited. Such evidence can improve our understanding when designing interventions for pulmonary rehabilitation that aim at increasing or maintaining participation in these activities. The aim of this study was to describe how people living with COPD experience and manage everyday life activities. MATERIALS AND METHODS: The sample comprised four males and four females with an age ranging from 65-87 years. Participants were interviewed in their own homes regarding experiences of performing and managing everyday life activities. Data were transcribed verbatim and analysed using content analysis. RESULTS: Findings from this study comprised the theme "Juggling to manage everyday life activities with COPD" and three categories representing the elements of this theme: (1) consequences of COPD symptoms, (2) adjustment of activities, and (3) contextual aspects. CONCLUSION: This study found the participants with COPD juggling the management of everyday life activities. The juggle generated a manageable daily life, which came at the expense of making deliberate choices and prioritizing everyday life activities that were necessary for participation in valued and engaging activities in order to maintain health and well-being. Implications for Rehabilitation People living with COPD experience a complex juggling between the consequences of COPD symptoms and contextual aspects when managing everyday life activities. The participants had largely accepted their disease and adjusted to their situation. The disease was still described as frustrating and generated less focus on making deliberate choices and prioritizing everyday life activities that are necessary for participation in valued and engaging activities. Health professionals need to support people living with COPD in making deliberate choices in order to continue participating in valued and engaging everyday life activities as they affect health and well-being. Pulmonary rehabilitation should focus more on supporting participation in social relations and on using everyday technologies

Design and management features of everyday technology that challenge older adults

Introduction: The management of everyday technologies could present too difficult a challenge for older adults with cognitive impairments, leading to their exclusion from participation. The present study aims to identify and describe features that make everyday technologies more or less difficult for older adults, whether with or without cognitive difficulties. Methods: A pre-existent, empirically generated hierarchy of more to less difficult everyday technologies was analysed. A mixed methods design was used to investigate predefined assumptions. Findings: Correlation analysis indicated that the more difficult everyday technologies required a higher frequency of skill actions; a positive correlation between the difficulty of an everyday technology and the need to perform actions in a logical sequence when using it was identified. The analysis indicated that feedback provided to users by less difficult everyday technologies consisted of different modes of stimuli (visual, auditory and tactile), while that from more difficult everyday technologies provided a high frequency of complex visual feedback. The less difficult everyday technologies were designed in a manner that was more intuitive; the design guided the user and fewer errors could be made. Conclusion: This study presents several features in the design of everyday technologies, and the skills required in using them, that could make their management more difficult for older adults