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

Abstract: 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).