New technology and everyday functioning at home for persons with cognitive impairments after acquired brain injury

The thesis comprises four studies focusing on developing knowledge about the possibilities that new technology and compensatory training can offer to enable everyday activities for persons with cognitive impairments after acquired brain injury (ABI). In Study I the participants received a home-based cognitive training program in their own home environment. In Study II new kinds of electronic memory aids previously not used for patients with cognitive impairments were developed and installed in a training apartment in the hospital. Patients stayed for five days each to learn and use the electronic memory aids in everyday activities. In Study III the participants moved to two study apartments for long-term use (4 or 6 months) with a set of electronic memory aids. In Study IV an electronic memory aid with wireless sensors was installed in the participants` own home to give spoken reminders for selected activities. The results in Studies III and IV demonstrated that the participants perceived the electronic memory aids to be useful and most wanted to continue to use them after the intervention. The results indicate that the use of electronic memory aids in everyday activities can increase everyday functioning and independence as well as satisfaction with performance, quality of life and safety for the user and their families, and also unburden their spouses (Studies III and IV). It was also shown that it is important to include family in decisions and assessments to be able to adapt the electronic memory aid to meet the users and families preferences to the extent possible (Study IV). In Study I the results showed that the persons with memory impairments improved in memory and attention, though they had previously participated in rehabilitation at the rehabilitation clinic and spontaneous recovery was ruled out. In studies II and III, the findings showed that persons with cognitive impairments could learn to use multiple electronic memory aids by intensive training and support from an occupational therapist, but there were great differences in the time needed (Study III). The results in Study IV showed that four of five participants improved in remembering to perform the selected activities with support by spoken reminders. The findings showed that electronic memory aids with an intuitive interface were easy to use and hardly any training was needed (Studies III and IV). Complex electronic memory aids that had to be used in different steps were difficult to learn and training was needed over a longer time (Studies II and III). Electronic memory aids that forced new behaviors on existing routines constitute hinders for learning (Studies II and III). There were problems with the technology during the studies, indicating the need for testing the usability of the technology in healthy subjects before applying the technology to persons with disabilities. There is also a need to increase collaboration with engineers to develop appropriate electronic memory aids for persons with memory impairments. In conclusion, it is possible for persons with mild and moderate memory impairments after ABI to learn how to use multiple electronic memory aids with training and support by an occupational therapist (Studies II, III and IV). Factors influencing learning were the design of the electronic memory aid and the severity of memory impairment, which effected the time needed to learn how to use the aid (Studies II, III and IV). The results indicate that there is a large potential for electronic memory aids to enable persons with mild to moderate memory impairments after ABI to carry out everyday activities and increase independence, safety, satisfaction with performance and quality of life for the users, and also unburden their spouses (Studies II, III and IV). The results indicate the need for individual assessments of both cognitive capacity and specific activity needs to match electronic memory aids to the user (Studies II, III and IV)

Co-Exploring Everyday Life of Adults with ADHD

There are relatively few studies based on an individual adult perspective on ADHD which takes into account how various factors interact and affect everyday life. Compensatory strategies can facilitate life for people with ADHD and those strategies might include the use of assistive technology or cognitive support. The purpose of this paper is to present and discuss how various factors can facilitate or challenge a person's tendency to adopt technology to better meet the demands and expectations of adult life. Participant observations and narrative interviews were used while co-exploring the life of three adults diagnosed with ADHD. By using this method the participants' own solutions, adaptions and preferences regarding cognitive support and assistive technology become visible. Results showed that factors like negative symptoms, stress, sleep deprivation, financial- or social problems effected the participant's motivation, feelings of competence, ability to identify prioritized activities and to maintain supportive routines – things that have been proven to be important for assistive technology use. Developing useworthy support and technology that meets the needs of people with ADHD is important in order to enable autonomy and compensate for the impairment

Feasibility of an Intervention for Patients with Cognitive Impairment Using an Interactive Digital Calendar with Mobile Phone Reminders (RemindMe) to Improve the Performance of Activities in Everyday Life

The aim of this study is to increase evidence-based interventions by investigating the feasibility of an intervention using an interactive digital calendar with mobile phone reminders (RemindMe) as support in everyday life. Qualitative and quantitative data were collected from participating patients (n = 8) and occupational therapists (n = 7) from three rehabilitation clinics in Sweden. The intervention consisted of delivering the interactive digital calendar RemindMe, receiving an individualized introduction, a written manual, and individual weekly conversations for two months with follow-up assessments after two and four months. Feasibility areas of acceptability, demand, implementation, practicality, and integration were examined. Patients expressed their interest and intention to use RemindMe and reported a need for reminders and individualized support. By using reminders in activities in everyday life their autonomy was supported. The study also demonstrated the importance of confirming reminders and the possible role of habit-forming. Occupational therapists perceived the intervention to be useful at the rehabilitation clinics and the weekly support conversations enabled successful implementation. This study confirmed the importance of basing and tailoring the intervention to patients needs and thus being person-centered.Funding Agencies|VR-FORTE [2014-4100]; Research and scholarship management in Region Ostergotland [LIO-815111]; Swedish Stroke Association (STROKE-Riksforbundet)</p

Lack of time and dependence on significant others : Occupational therapists´ experiences of prescribing time assistive technology for persons with dementia.

Background: There is lack of knowledge on how occupational therapists (OTs) assess daily time management (DTM) for persons with dementia (PwDs) and on which aspects affect prescription of time assistive technology (AT).Aim: To explore OTs' experiences of assessing the need for and prescribing time AT for PwDs.Material and methods: Focus group interviews with OTs that prescribe time AT for PwDs analyzed via qualitative content analysis.Results: A main category and four categories were identified. The categories illustrated a complex and time-consuming prescription process, which was facilitated if the PwD was supported by a significant other (SO). Support from a SO was especially important during implementation and follow-up. OTs had to take individual responsibility for staying informed about time AT. Organizational limitations and time constraints were barriers for OTs striving to work according to national prescription guidelines.Conclusions and significance: High demands are made on SO's participation during the prescription process. PwDs with no support from SOs are at risk not receiving or fully benefitting from time AT. To avoid inequalities, specific forms of support need to be developed and targeted at PwDs without SOs to ensure that they have sufficient opportunities to access and use time AT