The current study examined whether cognitive rehabilitation delivered over the Internet was associated with improvements in functioning.
A total of 14 individuals with medically documented traumatic brain injury completed this study. Participants completed 30 sessions of an active calendar acquisition intervention and 30 sessions of a control diary intervention in a cross-over study design for a total of 60 online sessions. All sessions were completed using an instant messaging system via the Internet. Measures of cognitive functioning, ratings of memory and mood and frequency of use of common memory and cognitive compensation techniques were gathered from participants and family members.
There were no significant differences between the active and control conditions on the primary outcome measure of memory functioning. However, significant improvements in use of compensatory strategies as well as family reports of improved memory and mood were observed following completion of all sessions. Individuals with less use of compensatory strategies at baseline were significantly less likely to complete the study.
These results suggest that the Internet may be an effective delivering mechanism for compensatory cognitive rehabilitation, particularly among individuals who are already utilizing some basic compensatory strategies.
"calendar, planners, cue cards) with each compensatory technique rated on a 7-point Likert scale. Selected questions were used from this instrument based upon our prior research (Bergquist et al, 2009). "
[Show abstract][Hide abstract] ABSTRACT: Persons with severe functional disabilities are the highest users of health care services. Caring for the needs of this population represents a significant percentage of our national health care costs. A growing body of research has demonstrated the efficacy of self-management strategies and caregiver engagement for effective long-term care for individuals with chronic medical conditions. Economic forces over the past decade have led to new challenges and resulted in major changes in health care delivery resulting in shortened length of inpatient stays and greater limits on the length of outpatient treatment. Telehealth is an innovative method for health care delivery and a means of meeting this new challenge. This article highlights the findings of 3 pilot studies on the use of telecommunications technologies in promoting self-care management and enhancing health care outcomes in persons with severe disabilities and their family caregivers. The importance of matching technology to the needs of this population, lessons learned from these investigations, and future directions for research are addressed.
"Using an instant messaging system over the internet, participants interacted with a therapist on the internet and were taught to use a calendar and a diary to compensate for memory problems. Results showed evidence for improved memory and mood following completion of all sessions and suggest that internet based cognitive rehabilitation may be beneficial . Also, Arundine and colleagues incorporated telephone cognitive behavioural therapy (CBT) in their assessment of psychological distress among ABI patients and found commensurate benefits of telephone CBT relative to conventional treatment . "
[Show abstract][Hide abstract] ABSTRACT: The aim of this paper is to examine factors associated with discharge destination after acquired brain injury in a publicly insured population using the Anderson Behavioral Model as a framework.
We utilized a retrospective cohort design. Inpatient data from provincial acute care records from fiscal years 2003/4 to 2006/7 with a diagnostic code of traumatic brain injury (TBI) and non-traumatic brain injury (nTBI) in Ontario, Canada were obtained for the study. Using multinomial logistic regression models, we examined predisposing, need and enabling factors from inpatient records in relation to major discharge outcomes such as discharge to home, inpatient rehabilitation and other institutionalized care.
Multinomial logistic regression revealed that need factors were strongly correlated with discharge destinations overall. Higher scores on the Charlson Comorbidity Index were associated with discharge to other institutionalized care in the nTBI population. Length of stay and special care days were identified as markers for severity and were both strongly positively correlated with discharge to other institutionalized care and inpatient rehabilitation, compared to discharge home, in both nTBI and TBI populations. Injury by motor vehicle collisions was found to be positively correlated with discharge to inpatient rehabilitation and other institutionalized care for patients with TBI. Controlling for need factors, rural location was associated with discharge to home versus inpatient rehabilitation.
These findings show that need factors (Charlson Comorbidity Index, length of stay, and number of special care days) are most significant in terms of discharge destination. However, there is evidence that other factors such as rural location and access to supplemental insurance (e.g., through motor vehicle insurance) may influence discharge destination outcomes as well. These findings should be considered in creating more equitable access to healthcare services across the continuum of care.
[Show abstract][Hide abstract] ABSTRACT: This study looked at patient satisfaction with an Internet-based cognitive rehabilitation program, which has been previously shown to be associated with functional improvements.
Fourteen individuals with documented traumatic brain injury and memory impairments completed this study. Participants completed 60 sessions of Internet-based cognitive rehabilitation: 30 sessions of an active calendar intervention and 30 sessions of a control diary intervention. A four-question satisfaction questionnaire (responses were generated using a seven-point Likert scale) was completed after 30 sessions and again after 60 sessions.
No significant differences in satisfaction were found between time of assessment and treatment condition. In addition, a higher level of calendar use prior to beginning the study was associated with greater satisfaction at study completion.
These results suggest that persons with traumatic brain injury are not only willing to use the Internet to receive cognitive rehabilitation treatment, but are generally highly satisfied with the treatment. Further, individuals with some baseline compensatory strategies may be particularly well suited to this method of treatment.
Telemedicine and e-Health 05/2010; 16(4):417-23. DOI:10.1089/tmj.2009.0118 · 1.67 Impact Factor
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