ORIGINAL PAPER

A profile of community navigation in adults with chronic cognitive impairment

Opening the black box of cognitive rehabilitation: Integrating the ICF, RTSS, and PIE

Cognitive rehabilitation is a complex and specialized area of practice, as it aims to support individuals with diverse neuropsychological profiles, personal characteristics, and intersectionalities in achieving meaningful, functional change in personally relevant aspects of their everyday lives. In many ways, cognitive rehabilitation is the epitome of a ‘black box’: it has complicated internal processes that are mysterious to users. We argue that this complex practice has suffered from a lack of specificity of clinical processes and treatment components, resulting in negative consequences for both providers and clients. Our aim is to unpack the black box of cognitive rehabilitation by describing a unifying set of frameworks that can effectively direct clinical practice across clinical disciplines: the International Classification of Functioning, Disability, and Health (ICF), the Rehabilitation Treatment Specification System (RTSS), and the Planning, Implementation, and Evaluation framework (PIE). We present a clinical case that illustrates the application of the three frameworks. Implementation of these three integrated frameworks supports clinical reasoning, replication of treatments, and communication across disciplines with the ultimate impact of improving rehabilitation outcomes. The frameworks provide a structure for clinicians to clearly define both the what and the how of treatment, with a level of specificity to maximize both effectiveness and efficiency of intervention

Proposed criteria for appraising goal attainment scales used as outcome measures in rehabilitation research

Goal Attainment Scaling (GAS) is a method for writing personalized evaluation scales to quantify progress toward defined rehabilitation goals. In the published literature, GAS methodology is used with different levels of rigor, ranging from precisely written GAS scales that ensure minimal bias and explicitly describe 5 levels of goal attainment to subjective ratings of goal attainment by adjectives (eg, worse/better than expected), which are transformed into a T score, wrongly giving the reader the impression of a truly standardized, interval scale. A drawback of GAS methodology is that it is highly dependent on the ability of the GAS setting team/person to generate valid, reliable, and meaningful scales; therefore, reliability and validity of GAS scales are idiosyncratic to each study. The aims of this article were to (1) increase awareness of potential sources of bias in GAS processes; (2) propose GAS quality appraisal criteria, allowing judgment of the quality of GAS methodology in individual rehabilitation studies; and (3) propose directions to improve GAS implementation to increase its reliability and validity as a research measurement tool. Our proposed quality appraisal criteria are based on critical appraisal of GAS literature and published GAS validity studies that have demonstrated that precision, validity, and reliability can be obtained when using GAS as an outcome measure in clinical trials. We recommend that authors using GAS report accurately how GAS methodology was used based on these criteria

Investigating the usability of assistive user interfaces. Interacting with Computers

A prototype e-mail system was developed for cognitively disabled users, with four different interfaces (free format, idea prompt, form fill and menu driven). The interfaces differed in the level of support provided for the user and complexity of facilities for composing e-mail messages. Usability evaluation demonstrated that no one interface was superior because of individual differences in usability problems, although the majority of users preferred interfaces which did not restrict their freedom of expression (free format). In contrast to traditional evaluation studies, no common pattern of usability errors emerged, demonstrating the need for customisation of interfaces for individual cognitively disabled users. A framework for customising user interfaces to individual users is proposed, and usability principles derived from the study are expressed as claims following the task artefact cycle

Transforming Cognitive Rehabilitation Effective Instructional Methods

Grounded in cutting-edge knowledge about cognitive function and recovery from brain injury, this practical reference and text incorporates major advances in the field to provide a new framework for assessing clients and developing individualized rehabilitation plans. The distinguished authors present principles and procedures for promoting engagement, teaching cognitive strategies and discrete facts and routines, introducing external cognitive aids, and supporting clients' social competence. Additional topics include considerations for using computer-based training, managing functional cognitive symptoms, and providing cognitive rehabilitation in the inpatient setting