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Why people use and don’t use technologies: Introduction to the special issue on assistive technologies for cognition/cognitive support technologies

  • Institute for Matching Person and Technology
  • University of Perugia. Italy


This special issue focuses on assistive technologies for cognition/cognitive support technologies as well as the ways in which individuals are assessed and trained in their use. We provide eleven diverse articles that give information on products, why they are used and not used, and best professional practices in service provision. Our goal is to highlight a broad topic that has received limited research investigation and offer an insight into how different countries and programs are promoting access to and use of assistive technologies for cognition/cognitive support technologies.
NeuroRehabilitation 37 (2015) 315–319
IOS Press
Guest Editorial
Why people use and don’t use technologies:
Introduction to the special issue on assistive
technologies for cognition/cognitive support
Marcia J. Scherera,and Stefano Federicib
aInstitute for Matching Person & Technology, Webster, NY, USA
bUniversity of Perugia, Perugia, Italy
Abstract. This special issue focuses on assistive technologies for cognition/cognitive support technologies as well as the ways
in which individuals are assessed and trained in their use. We provide eleven diverse articles that give information on products,
why they are used and not used, and best professional practices in service provision. Our goal is to highlight a broad topic that
has received limited research investigation and offer an insight into how different countries and programs are promoting access
to and use of assistive technologies for cognition/cognitive support technologies
Keywords: Assistive technology devices, assistive technology services, cognitive support technologies, nonuse, abandonment,
Matching Person and Technology Model, brain injury
1. Introduction
Many neurorehabilitation professionals work with
individuals with a combination of cognitive, physical,
sensory or other disabilities and chronic health con-
ditions and at various stages along the rehabilitation
continuum. This special issue discusses the potential of
a variety of devices for individuals ranging from those
in a minimally and supports conscious state to those par-
ticipating in education and the workplace. To illustrate
this wide range of topics, we begin with a review arti-
cle by Federici, Meloni, Bracalenti and De Filippis that
examines the utility of current active, powered, wear-
able lower limb exoskeletons and their load on working
memory and cognition for paraplegic patients with
Address for correspondence: Marcia J. Scherer, Institute for
Matching Person & Technology, 486 Lake Road, Webster, NY 14580,
USA. Tel./Fax: +1 585 671 3461; E-mail:
gait disorders resulting from central nervous system
lesions. The article by Lancioni, Singh, O’Reilly et al.
presents the positive effects found in the use of a
technology-aided approach to foster responding and
stimulation control in individuals in a post-coma min-
imally conscious state. The contribution by Bilancia,
Marazz and Filippi discusses a treatment method for an
individual with a Specific Learning Disorder involving
reading and writing difficulties through an interven-
tion based on the integration of a sublexical method
and a neuropsychological approach along with assistive
technologies. Leslie, Kinyanjui, Bishop, et al. con-
ducted a large-scale analysis of workers in the USA
with multiple sclerosis and cognitive and functional
limitations. They addressed who utilizes workplace
accommodations, the types of accommodations most
frequently required, and differences in disease vari-
ables, job-related factors, and quality of life between
workers using and not using work accommodations.
1053-8135/15/$35.00 © 2015 IOS Press and the authors. All rights reserved
316 M.J. Scherer and S. Federici / Guest Editorial
Support from technology can come from various
mainstream or everyday technologies such as comput-
ers and smartphones, as well as specialized products
that become an integral part of that person’s func-
tioning, persona and self-image such as exoskeletons,
wearable cuing devices, and wearable cameras.
Assistive technology devices (ATDs) have a U.S. fed-
eral definition and are mandated to be considered in
several laws such as the Individuals with Disabilities
Education Act (IDEA). Specialized products or ATDs
include wheelchairs, walkers, communication devices,
products to augment hearing and vision and many more.
Individuals with cognitive disabilities may use any
of these as well as specialized software and apps for
memory, executive functioning, and so on in combina-
tion with personal assistance and cognitive/behavioral
An ATD is what the person uses. How they obtain
and maintain it and master its use falls under the
purview of assistive technology services. Professionals
increasingly are better able to respond to consumers’
different needs and preferences because the variety of
technology options continues to expand. However, as
noted in the review article by Leopold, the increased
availability of technology options has made the process
of matching a person with the most appropriate device
more complex because people’s predisposition to,
expectations for, and reactions to and benefit from tech-
nologies and their features are highly individualized
and personal.
In addition to the needs and preferences of the user, a
good match of person and technology requires attention
to aspects of the environments in which the technology
will be used and the various functions and features of
the technology. If the match is not a quality one from
the standpoint of the consumer, the technology may
not be used, or will not be used optimally. Such varied
outcomes are (Scherer, 2005a):
1. optimal use under all recommended conditions
and situations,
2. partial use, where it is used in some situations but
not others or part of the time,
3. non-use, where the technology was once used but
is set aside perhaps because it is no longer needed,
4. avoidance of use, where use is not even consid-
5. reluctant use, where the individual uses it but does
so with displeasure,
6. abandonment, or permanently giving up use usu-
ally out of frustration or annoyance.
Categories 1–3 can be considered a successful out-
come of the process if the individual reports realization
of benefit from using or having used the technology.
Categories 4–6, however, indicate a failure of the pro-
cess to serve that individual well. Indeed, the overall
non-use or abandonment rate has been approximately
30% for the past thirty years (Scherer, 2014).
We know that there are highly individualized rea-
sons for AT non-use and abandonment. In addition
to the nature of the functional need for the AT and
related functional capabilities/limitations of the per-
son, these reasons arise from consumer (1) personal
factors, including preferences and expectations, and
(2) judgments of the subjective useworthiness of the
device and doworthiness of the task that directly impact
device use and non-use. Research conducted by the
authors has revealed factors common to people who
later stopped using and abandoned their device (see the
recent study on assistive technology abandonment by
Federici, Meloni, and Borsci (in press)). These factors
are summarized in Table 1 according to three primary
influences: of the characteristics of the environment,
person, and technology (Scherer, 2005a).
Persons with disabilities differ as much personally
as they do functionally. They bring expectationsto the
support selection process that are internal and external.
Table 1
Factors associated with device non-use according to characteristics of the characteristics of the environment, person, and technology
Environment Person Technology
Non use Lack of a user-centered process Unrealistic expectations of benefit Discomfort/strain in use
for technology selection Embarrassed or self-conscious Obtrusive and intrusive to use
Little or no support for use from about using device Is incompatible with the use of
family/peers/employer Resistant to help from technology other devices
Setting/environment discourages use or Doesn’t like a device’s discipline Is too unwieldly, heavy
makes use difficult or uncomfortable Many changes in lifestyle with Is complex and difficult to use
Requires support that is not available device use Device is inefficient
Device choice made by someone else Lacks skills to use device and Repairs/service not timely or affordable
training not available Other and preferred options are available
Doesn’t trust technology
Source: Institute for Matching Person & Technology as adapted from Scherer (2005a).
M.J. Scherer and S. Federici / Guest Editorial 317
Table 2
Condensed options consumers can choose to indicate why they stopped using an assistive technology device
Assistive Technology Device Predisposition Assessment Follow-up Consumer Form: Reasons for Not Using One or More Devices
a. *It broke and I can’t use it1g. *#I felt self-conscious using it3
b. *#%&It was too inconvenient to use1h. *I didn’t get the training I needed to use it well2
c. *#It wasn’t the right device for me1i. #&It didn’t fit with my needs/preferences/lifestyle3
d. *#%It didn’t help as much as I hoped3j. *#I replaced it with a different device or support. 1What?
e. *#&It was too complicated to use1k. I no longer need to use it because:4
f. *#&It costs too much money to use1l. Other:
g. #&The purpose for using the device isn‘t important to me
1characteristics of the device and its selection for the person. That is, it was a poor selection and decision-making process. 2training for use.
3characteristics and preferences of the person. 4could be due to the person getting better but regardless, it is a body functions and structures item.
*usability; # useworthiness; % doability; & doworthiness.
They carry the expectations of parents, teachers,
employers, peers, and society in general that reflect
varying values and cultural priorities. Individuals also
place expectations on themselves that have evolved
from their prior history with support use, the edu-
cational system and so on. Their particular level of
motivation, judgment, and outlook, and many other fac-
tors serve to combine in a way that defines each as a
unique individual. It is important to note that these influ-
ences interact and affect one another, and can change
with the passage of time and accumulation of experi-
ence. Thus, at a given point in time, each person has a
predisposition to view technology use as being favor-
able or not for certain purposes and in particular settings
or environments. This is well exemplified in the con-
tribution by Adolfsson, Lindstedt and Janesl¨
att who
conducted a qualitative examination of the experiences
of twelve individuals who used electronic planning
The attitudes of providers and their expectations of
the individual can have a profound influence on persons
with disabilities and their expectations of themselves.
What may seem to be a vital task to the individual
may be given little attention by the provider, and vice
versa. Thus, to achieve a good match of person and
technology, it is important that the potential tech-
nology user be paired with a well-informed and
person-centered provider and that the degree to which
consumer and provider perspectives are shared is
The most important influence on an individual’s use
of the selected support is how well it actually serves
that person. That is, how much it helps the individual
accomplish desired goals and activities, fits with his
or her lifestyle, routines, and preferences and does not
result in stress and frustration, and enhances well-being.
Therefore, also considering individual’s affective and
emotional states can improve the process of matching
person and technology. To this end, Liberati, Fed-
erici and Pasqualotto performed a systematic review of
studies investigating the recognition of emotions from
neurophysiological signals, in order to improve the use
of brain-computer interfaces (BCIs), by adapting them
to the user’s needs.
When the goal involves support from technologies,
key factors for consideration are motor skills, moti-
vation and psychological readiness for use. For many
users of assistive technologies, their devices become
an extension of the self, not just to themselves but
also to other persons. The device, then, is incorporated
into the individual’s identity. But this process can be
difficult for some, thus leading to underutilization
or nonuse.
2. Personal and technology factors
The individual’s use of an AT will be affected sig-
nificantly by characteristics of the device itself as well
as the priorities and preferences of the person. Accord-
ing to Oskar Krantz (2012), device usability (that is, its
size, weight, durability, etc.) may or may not correlate
with the subjective determination of its “useworthi-
ness.” Krantz illustrates the differences in these terms,
as well as task doability and doworthiness, as follows:
A wheelchair with mechanical properties match-
ing the user (usability) increases the mobility of
the user, allowing for a greater number of activi-
ties (doability). However, the wheelchair has to be
worth using in order to be utilized (useworthiness)
and the activity has to be worth performing in order
to be performed (doworthiness) (p. 193).
Once the device is usable by the person, then the per-
son has to value the task or purpose for which the device
is intended. Thus, useworthiness is related to individual
318 M.J. Scherer and S. Federici / Guest Editorial
values and judgement whereas usability can be more
objectively measured. Useworthiness and usability both
need to be present for a good match of person and
device. AAC devices provide a good example. A per-
son may be able to use one very proficiently. But if the
person prefers to have a caregiver speak for them to
conserve energy then it lacks useworthiness.
In line with Federici and Borsci (2014), dowor-
thiness and useworthiness, as well as usability and
environments of use (Mirza, Gossett Zakrajsek, &
Borsci, 2012), are factors that have to be considered
by providers during the process of technology selec-
tion and delivery. In fact, a strong relationship was
found between the quality of the delivery processes of
providers and the likelihood of technology abandon-
ment. The more the providers applied a user-centered
approach and took into account key personal factors,
the more likely it was that people used the technology
(Federici & Borsci, 2011, 2014).
2.1. Matching Person and Technology (MPT)
Table 2 depicts a section of the Assistive Technol-
ogy Device Predisposition Assessment, one form in the
Matching Person and Technology Model and Assess-
ment Process (Scherer, 2005b). The Matching Person
and Technology (MPT) Model has been described in a
trilogy of books (Scherer, 2004, 2005a, 2014) as well
as an edited volume on assistive technology assessment
(Federici & Scherer, 2012) and a journal article (Scherer
& Craddock, 2002).
Fundamentally,theMPTModelhas three crucialareas
of foci that represent the primary biopsychosocial com-
ponents that most influence use of assistive technologies
(see Table 1): (a) The needs, preferences and character-
istics of the unique person (b) the milieu/environment(s)
in which the user will interact with the technology,
and (c) the functions and features of the most desir-
able and appropriate technology. The MPT model
was operationalized by developing an evidence-based,
client-centered assessment for determining the match of
individuals with the most appropriate technologies for
their use. The assessment process consists of a series of
measures that provide a person-centered and individu-
alized approach to matching individuals with the most
appropriate technologies for their use. It has been the
foundation for research by others internationally and
has been translated into multiple languages. Examples
of its use in the USA are provided by the contribu-
tions from researchers associated with Project Career, an
effort to assess and address the needs of adults with trau-
matic brain injuries enrolled in college across multiple
institutions. These articles were written by Hendricks,
Sampson,Rumrillet al. andNardone,Sampson,Stauffer,
et al. An example of its use in acute and outpatient cog-
nitive rehabilitation is provided by Fleeman, Stavisky,
Carson, et al. It has also been found helpful in training
individuals in the use of assistive technologies for cog-
nition/cognitive support technologies (Powell, Glang,
Pinkelman, et al.).
Successfully treating, supporting and empowering
consumers and their families to live with neurological
disability involves more than medical intervention.
As Williams and Edwards (2003) have claimed in
the special issue on Biopsychosocial Approaches in
Neurorehabilitation, much of what happens in neu-
rorehabilitation requires understanding the complex
interaction of biological, psychological and social
influences on affect and behavior. In this special issue,
we intend to provide insights to neurorehabilitation
professionals and experts in how different countries and
programs are promoting access to and use of assistive
technologies for cognition according to a biopsycho-
logical approach. Overcoming a neurological issue
through the use of an assistive technology requires
more than just a device. It requires matching that
device or support to the person’s preferences and char-
acteristics, and to evaluate the interaction of the device
with the family and the environments of everyday
The development and validation of the Matching Per-
son and Technology Model and assessments were made
possible by funding from the following sources:
Centers for Disease Control and Prevention, Grant
number DD000219 to the Institute for Matching Person
& Technology, Inc. for the project, Matching Assistive
Technology and CHild (MATCH).
National Institutes of Health, National Institute of
Child Health and Human Development, National Cen-
ter for Medical Rehabilitation Research. Grant number
HD052310 to The Institute for Matching Person &
Technology, Inc. for the project, Improving the Match
of Person and Assistive Cognitive Technology.
National Institutes of Health, National Institute of
Child Health and Human Development, National Cen-
ter for Medical Rehabilitation Research. Grant number
HD38220 to The Institute for Matching Person &
M.J. Scherer and S. Federici / Guest Editorial 319
Technology, Inc. for the project, Improving the Match
of Person and Mobility Technology.
National Science Foundation, Ethics and Values
in Science and Technology and Biotechnology &
Research to Aid the Handicapped. Grant number RII-
8512418 for research project, Improving Technological
Innovations for People with Physical Disabilities.
Adolfsson, P., Lindstedt, H., & Janesl¨
att, G. (2015). How Persons with
Cognitive Disabilities Experience Electronic Planning Devices.
NeuroRehabilitation,37(3), 379-392.
Bilancia, G., Marazz, M., & Filippi, D. (2015). Neurorehabilitation
applied to Specific Learning Disability: Study of a single case.
NeuroRehabilitation,37(3), 405-423.
Federici, S., Meloni, F., & Borsci, S. (In press). The Abandonment of
Assistive Technology in Italy: A Survey of Users of the National
Health Service. European Journal of Physical and Rehabilitation
Federici. S., Meloni, F., Bracalenti, M., & De Filippis, M.L. (2015).
The effectiveness of powered, active lower limb exoskeletons in
neurorehabilitation: A systematic review. NeuroRehabilitation,
37(3), 321-340.
Federici, S., & Borsci, S. (2011). The use and non-use of assistive
technology in Italy: A pilot study. In G. J. Gelderblom, M. Soede,
L. Adriaens, & K. Miesenberger (Eds.), Everyday Technology for
Independence and Care: AAATE 2011 (Vol. 29, pp. 979–986).
Amsterdam, NL: IOS Press. DOI: 10.3233/978-1-60750-814-4-
Federici, S. & Borsci, S. (2014). Providing Assistive Technology:
The perceived delivery process quality as affecting abandon-
ment. Disability and Rehabilitation: Assistive Technology, 1–10.
Federici, S. & Scherer, M. J. (Eds.). (2012). Assistive Technology
Assessment Handbook. Boca Raton, FL: CRC Press. ISBN-13:
Fleeman, J.A., Stavisky, C., Carson, S., Dukelow, N., Maier, S.,
Coles, H., Wager, J., Rice, J. Essaff, D., & Scherer, M. (2015). A
Preliminary Program Description and Theoretical Review of an
Interdisciplinary Cognitive Rehabilitation Program. NeuroReha-
bilitation,37(3), 471-486.
Hendricks, D.J, Sampson, E., Rumrill, P., Leopold, A., Elias, E.,
Jacobs, K., Nardone, A. Scherer, M., & Stauffer, C. (2015). Activ-
ities and Interim Outcomes of a Multi-Site Development Project
to Promote Cognitive Support Technology Use and Employment
Success Among Postsecondary Students with Traumatic Brain
Injuries. NeuroRehabilitation,37(3), 449-458.
Krantz, O. (2012). Assistive device utilization in activities of
everyday life: A proposed framework of understanding a user
perspective. Disability & Rehabilitation: Assistive Technology,
7(30), 189-198. DOI: 10.3109/17483107.2011.618212
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., D’Amico,
F., Buonocunto, F., Navarro, J., Lanzilotti, C., Fiore, P. Megna,
M., & Damiani, S. (2015 ). Assistive Technology to Help
Persons in a Minimally Conscious State Develop Responding
and Stimulation Control: Performance Assessment and Social
Rating. NeuroRehabilitation,37(3), 393-403.
Leopold, A., Lourie, A., Petras, H., & Elias, E. (2015). The Use of
Assistive Technology for Cognition to Support the Performance
of Daily Activities for Individuals with CognitiveDisabilities Due
to Traumatic Brain Injury: The Current State of the Research.
NeuroRehabilitation,37(3), 359-378.
Leslie, M., Kinyanjui, B., Bishop, M., Rumrill, P. D., & Roessler, R. T.
(2015). Patterns in Workplace Accommodations for People with
Multiple Sclerosis to Overcome Cognitive and Other Disease-
Related Limitations. NeuroRehabilitation,37(3), 425-436.
Liberati, G., Federici, S., & Pasqualotto, E. (2015). Extracting neu-
rophysiological signals reflecting users’ emotional and affective
responses to BCI use: A systematic literature review. NeuroRe-
habilitation,37(3), 341-358.
Mirza, M., Gossett Zakrajsek, A., & Borsci, S. (2012). The Assess-
ment of the Environments of Use: Accessibility, Sustainability,
and Universal Design. In S. Federici & M. J. Scherer (Eds.),
Assistive Technology Assessment Handbook (pp. 67–81). Boca
Raton, FL: CRC Press. DOI: 10.1201/b11821-6
Nardone, A., Sampson, E., Stauffer, C., Leopold, A., Jacobs, K., Hen-
dricks, D. J., Elias, E., Chen, H., & Rumrill, P. (2015). Project
Career: A Qualitative Examination of Five College Students with
Traumatic Brain Injuries. NeuroRehabilitation,37(3), 459-469.
Powell, L. E., Glang, A. Pinkelman, S., Albin, R., Harwick, R., Ettel,
D., & Wild, M. (2015). Systematic instruction of assistive tech-
nology for cognition (ATC) in an employment setting following
acquired brain injury: A single case, experimental study. Neu-
roRehabilitation,37(3), 437-447.
Scherer, M. J. (2014). From people-centered to person-centered ser-
vices, and back again. Disability and Rehabilitation: Assistive
Technology,9(1), 1-2. PMID: 24304239
Scherer, M. J. (2012). Assistive Technologies and Other Supports for
People with Brain Impairment. New York: Springer Publishing
Co. ISBN-13: 9780826106452
Scherer, M. J. (2005a). Living in the State of Stuck: How Assis-
tive Technology Impacts the Lives of People with Disabilities,
Fourth Edition. Cambridge, MA: Brookline Books. ISBN-13:
Scherer, M. J. (2005b). The Matching Person &Technology (MPT)
Model Manual and Assessments, 5th edition [CD-ROM]. Web-
ster, NY: The Institute for Matching Person & Technology, Inc.
Scherer, M. J. (2004). Connecting to Learn: Educational and Assis-
tive Technology for People with Disabilities. Washington, DC:
American Psychological Association (APA) Books. ISBN-13:
Scherer, M. J., & Craddock, G. (2002). Matching Person & Technol-
ogy (MPT) assessment process. Technology & Disability, Special
Issue: The Assessment of Assistive Technology Outcomes, Effects
and Costs,14(3), 125-131.
Williams, W. H., & Edwards, J. J. (2003). Brain injury and
emotion: An overview to a special issue on biopsychosocial
approaches in neurorehabilitation. In W. H. Williams & J. J.
Edwards (Eds.), Biopsychosocial Approaches in Neurorehabil-
itation: Assessment and Management of Neuropsychiatric, Mood
and Behavioral Disorders (pp. 1-11). Hove, UK: Psychology
Press. DOI: 10.1080/09602010244000444.
... Commonly used TADs are visual activity schedules, timers, and electronic planning devices, and they are often reported to increase independence and self-confidence [15][16][17][18][19][20][21]. However, insufficient support from the physical environment and insufficient introduction or not enough time training in the use of assistive devices can lead to non-use of provided TADs [22][23][24]. Due to difficulties with abstract thinking, people with ID may have difficulties in transferring experiences and knowledge from one situation or context to another and therefore may need support in doing so [25,26]. ...
... It is likely, therefore, that the group intervention did indeed help the participants to start using a calendar and to start finding out how and when a calendar is really useful. These findings are in line with what other studies have shown, that the perceived usefulness is crucial for products supporting cognitive functions [22,23,54]. To manage time in daily life in more than one context is more cognitively demanding than to manage time in a specific context such as in training and/or with a specific tool. ...
Background: Limited time management skills cause problems in daily life for people with mild intellectual disability (ID) and "Let's Get Organized" (LGO) is a promising manual-based occupational therapy group intervention aiming to support management skills. Aims/objectives: To evaluate the applicability of the Swedish version of LGO-S by i) exploring enhancements in time management skills, satisfaction with daily occupations, and aspects of executive functioning in people with time-management difficulties and mild ID, and ii) describing clinical experiences of using the LGO-S for people with mild ID. Material and methods: Twenty-one adults with mild ID were included. Data were collected pre-/post-intervention and at 3- and 12-month follow-ups with: Swedish version of Assessment of Time Management Skills (ATMS-S), Satisfaction with Daily Occupation (SDO-13), and Weekly Calendar Planning Activity (WCPA-SE). There were few follow-up participants (n = 6-9). Results: Significant change in time management skills that maintained at 12-months follow-ups. Significant increase in regulation of emotions at 12-month follow-up. Results at 12-months follow-up indicated sustainability in outcomes as measured by ATMS-S. A non-significant positive trend was observed in other outcomes between pre- and post-intervention. Conclusions and significance: LGO-S seems applicable for improving skills in time management, organisation and planning also for people with mild ID.
... A qualidade de vida geral e satisfação com a saúde obteve uma média de 4,09. O domínio físico alcançou a melhor média (3,62), seguido dos domínios meio ambiente (3,54) e psicológico (3,46), o domínio relações sociais apresentou a menor média (2,47). Conclui-se que a maioria dos usuários de cadeiras de rodas não estão satisfeitos com o serviço da TA, visto que muitos fatores relacionados a eles interferem nas relações sociais do cadeirante, tendo reflexo em sua qualidade de vida, uma vez que o domínio relações sociais apresentou a pior média. ...
... A qualidade de vida geral e satisfação com a saúde obteve uma média de 4,09. O domínio físico alcançou a melhor média (3,62), seguido dos domínios meio ambiente (3,54) e psicológico (3,46), o domínio relações sociais apresentou a menor média (2,47). Conclui-se que a maioria dos usuários de cadeiras de rodas não estão satisfeitos com o serviço da TA, visto que muitos fatores relacionados a eles interferem nas relações sociais do cadeirante, tendo reflexo em sua qualidade de vida, uma vez que o domínio relações sociais apresentou a pior média. ...
O objetivo deste estudo foi avaliar a qualidade de vida dos usuários de cadeira de rodas e o grau de satisfação quanto ao uso da tecnologia assistiva. Trata-se de uma pesquisa descritiva transversal, exploratória e quantitativa composta por 57 participantes, que responderam a três instrumentos: um questionário em relação ao perfil dos usuários de cadeira de rodas, o World Health Organization Quality of Life (WHOQOL-bref) e o Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). O nível de satisfação do usuário quanto ao recurso da tecnologia assistiva (TA) alcançou uma média de 3,05 e quanto ao serviço atingiram uma média de 2,71. Os itens que os cadeirantes estão mais satisfeitos são a eficácia (média de 3,42), facilidade de uso (média de 3,23) e dimensão (média de 3,11). Os itens de mais insatisfação são reparos e assistência técnica (média de 2,44), peso (média de 2,65) e serviço de acompanhamento (média de 2,75). A qualidade de vida geral e satisfação com a saúde obteve uma média de 4,09. O domínio físico alcançou a melhor média (3,62), seguido dos domínios meio ambiente (3,54) e psicológico (3,46), o domínio relações sociais apresentou a menor média (2,47). Conclui-se que a maioria dos usuários de cadeiras de rodas não estão satisfeitos com o serviço da TA, visto que muitos fatores relacionados a eles interferem nas relações sociais do cadeirante, tendo reflexo em sua qualidade de vida, uma vez que o domínio relações sociais apresentou a pior média.
... AR through a tablet or cellphone could be considered an assistive technology device (ATD) intended as specialised software and apps to assist a person with cognitive and behavioural strategies, where for a good person-technology match the preference of the users and attention to the aspects of the environment should be considered [47]. A person centred approach, following a systemic approach, could reduce device non-compliance, non-use and abandonment [48,49]. ...
... A person centred approach, following a systemic approach, could reduce device non-compliance, non-use and abandonment [48,49]. According to the Matching Person and Technology (MPT) model, factors related to use and non-use of devices are characteristics of three domains: 1) the user, considering his/her personal and psychological characteristics, needs and preferences; 2) the technology, considering its functions and features; and 3) the milieu/environmental factors [47,50,51]. This perspective is in line with the biopsychosocial model aimed at analysing the barriers and facilitators that occur in the interaction system in order to achieve the best combination of all its components [52,53], and it could be intended as an optimisation of the person environment fit reported by Lai et al. [6]. ...
Purpose Literature supports the use of technological tools such as augmented reality, 3 D avatars and mobile devices to improve individuals with autism spectrum disorder skills. Possibilities of including these technological tools in intervention and the critical issues related to intervention design are essential research questions. The aim of the current work is to present an interdisciplinary research study on the design of an autism intervention considering these technologies. Materials and methods This study used qualitative evidence and thematic analysis to identify the main design guidelines. A semi-structured interview was administered to a total of twenty participants representing four stakeholder categories: ASD, clinicians, therapists and caregivers. Interviews focussed on three dimensions related to user, technology and environment since they represent a complex system within which the individual using technology is situated. Results Thematic analysis of the interviews identified a total of 10 themes considered central to the design of the technological intervention. Conclusions Since the application of technology in autism intervention is a relatively new area, the guidelines related to the potential incentives and barriers of the proposed technology are helpful to inform future treatment studies. • Implications for Rehabilitation • This study highlights the strengths and barriers associated with the use of smartphones and augmented reality in autism spectrum disorder interventions considering the dimensions within which the user using assistive technology is located. • Strengths and major concerns that emerged are key points to consider during the development of the technological intervention. • Considering these points can foster the use of technology within the intervention and promote its effectiveness.
... Atualmente, poucos são os estudos que avaliam o impacto da CRM na funcionalidade e participação das pessoas com deficiência (CHOW; LEVY, 2010;HASTINGS et al., 2011;SALENTINE, 2012;FEDERICI, 2015;SMITH;SAKAKIBARA;MILLER, 2016;SUGAWARA et al., 2018;COSTA et al., 2015;BOIANI et al., 2015;MANDY;MEZADRI, 2019), e a maioria foi realizada em outros países, podendo não refletir a realidade brasileira. Diante disso, este estudo objetiva compreender os fatores que acarretam a satisfação ou insatisfação dos usuários de cadeira de rodas manual, quanto ao recurso e ao serviço. ...
Este trabalho teve como objetivocompreender os fatores que acarretam a satisfação ou insatisfação dos usuários de cadeira de rodas manual, quanto ao recurso e ao serviço. A pesquisa foi do tipo exploratória, descritiva e qualitativa. Os participantes da pesquisa foram as pessoas com deficiência física que utilizam a cadeira de rodas manual, residentes na cidade de Itajaí e na região do Vale do Itajaí, Santa Catarina. O instrumento de coleta de dados foi a entrevista semiestruturada que aconteceu na Clínica de Fisioterapia da Univali e no Centro Especializado em Reabilitação II (CERII). Participaram da pesquisa um total de dez usuários de cadeiras de rodas manuais. As categorias que emergiram foram: aspectos relacionados à satisfação e à insatisfação do uso da CRM e aspectos quanto aos serviços prestados aos usuários de CRM. Os participantes da pesquisa relataram que estão satisfeitos com suas cadeiras, quanto às dimensões e insatisfeitos quanto ao peso da cadeira, estável, que acarreta dor nas costas e nos braços. Quanto ao serviço especializado estão insatisfeitos quanto ao conserto de cadeira de rodas, a falta de profissionais da saúde para orientar e escolher sobre o uso da CRM e a falta de acessibilidade.
... However, the equivalent gains demonstrated by the groups provide preliminary support for use of SwapMyMoood as an adjunct option to conventional care, adding evidence for the feasibility of use of computerized technology for cognitive and behavioral interventions for people with brain injury [33][34][35]. Notably, participants were randomized to groups rather than matched to the intervention option (i.e., the paper manual or app) according to their preferences and abilities [36] as is appropriate for clinician implementation outside of research. Therefore, it is unknown whether matching persons to intervention options would yield different results. ...
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This pilot study assessed the feasibility of using SwapMyMood, a smartphone application supporting evidence-based strategies for emotion regulation and problem-solving as a supplement to conventional care for military service members and veterans (SM/Vs) experiencing chronic symptoms of mild traumatic brain injury (mTBI) and co-occurring psychological conditions. Eight military SM/Vs were recruited from an intensive outpatient program. Participants were block randomized to an experimental group (conventional care plus use of the SwapMyMood app) or a conventional care only group for six weeks. Conventional care included instruction on problem-solving and emotion regulation strategies using traditional paper manuals and protocols. Effects on the knowledge and use of strategies and related goal attainment were measured. Patient-reported outcomes were measured via several validated problem-solving and emotion regulation scales. No differences were found between groups in goal attainment, global executive function, problem-solving, emotion regulation, and knowledge of how to use the problem-solving and emotion regulation strategies targeted. Experimental group participants rated the application positively, demonstrating feasibility of integration of the app into clinical care. The implementation of SwapMyMood is feasible in a clinical setting. SwapMyMood may be a clinically effective supplemental tool for supporting executive function in SM/Vs with mTBI and co-occurring psychological conditions.
... In addition to difficulties in physical functioning, a common reason for the non-use of AT is that the users do not feel they can integrate the device into their identity and self-image [79,80]. Since the Hungarian national list of devices is definite, making choices regarding features such as color or design are mostly impossible. ...
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Based on notions from the Capability Approach, this study investigates the service delivery process for assistive technology in Hungary. The research aimed to explore whether the service delivery is person-centered, with a specific focus on the users’ possible choices. In addition to a comprehensive analysis of legislative and policy documents, qualitative data were collected in semi-structured interviews with users and professionals (n = 31) to gain a deeper understanding of personal experiences. Our findings indicate that the service delivery system is product-centered and dominated by financial considerations. The policy and legislation framework does not provide an institutional guarantee for users to be able to have their voices heard; the extent to which their opinions and preferences prevail depends on the attitude, knowledge, and goodwill of the professionals involved in the process. The realization of a person-centered approach will be hindered as long as the users’ needs are viewed from a medical point of view.
Purpose: This study aimed to investigate the provision and need for assistive products for older adults with cognitive impairment among rehabilitation therapists, identify any unmet needs, and analyze current issues in providing such products.Methods: We conducted a questionnaire survey with rehabilitation therapists involved in selecting and providing assistive products for cognitive function in older adults with cognitive impairments. Questionnaires comprising ten items about the experience and need for cognitive assistive products were sent to 300 facilities for older adults in Japan between January and February 2021. One hundred thirty-five responses were received.Results: The mean age of the participants was 39.5 ± SD7.1. There were 70 females, 64 males, and one unanswered questionnaire. In total, 72 (53.3%) of the 135 therapists had introduced or provided assistive products to their patients. The most frequently provided products were for safety and security; some were provided to support memory and orientation. 86% of therapists did not use the insurance system to provide them. The survey showed that most participants with experience providing assistive products needed information on the available resources.Conclusions: Although the need for assistive products for cognition is increasing, they are not sufficiently supplied in caring for older adults with cognitive impairment. Their availability differed depending on the assistive product type. It is necessary to have an effective social insurance system and access to up-to-date information to provide appropriate assistive products.
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Technologies have become smarter, smaller, more portable or wearable, and more adaptable. This has led to more choice and, in many cases, complexity in decision-making about selecting the best device and features for a given user. A good match of person and technology requires attention to (a) aspects of and resources in the environments in which the technology will be used, (b) the needs, expectations and preferences of the user, and (c) the functions and features of the technology and service delivery process. If the match is not a quality one from the standpoint of the end user, and the user experience (UX) is not satisfactory, then the technology may go unused, or may not be used optimally. There is a need for an improved person-AT matching and outcomes assessment process because studies and reports show in general that there is a high level of dissatisfaction and nonuse or discard of technology by consumers. Psychologists are uniquely qualified to partner with technology developers in implementing an assessment process that inquires into the potential technology user's predisposition to use a particular technology by addressing, subjective view of current capabilities, view of achievements as well as needs in key life domains of activities and participation, and ratings of fundamental personal factors such as mood status, support from others, engagement in therapy activities and desire to use technology. Utilization of the MPT model and accompanying assessment process has been proven to result in enhanced technology use and goal achievement. ADDITIONAL DESCRIPTION Research increasingly highlights the fact that consumers are less likely to use recommended devices when their needs are neither fully addressed nor understood during the technology selection process. A user's perspective of their needs and preferences may be obtained by having them identify and prioritize their desired outcomes and then rate progress in achieving them. This approach was used in developing the Matching Person and Technology measures and has also been used in developing Such a person-centered approach allows outcomes to be measured in reference to changes in a person's satisfaction in achieving desired goals, not merely their functional ability to achieve them. An idiographic evaluation is used (i.e., the person is the unit of analysis and serves as his or her own control), not a normative one (i.e., the person is compared to his or her peers). An idiographic evaluation best captures a consumer-directed and social model perspective of outcomes assessment. Many studies have examined the psychometric qualities and usefulness of the Matching Person and Technology measures. Below is the most recent data on one MPT measure, the Assistive Technology Device Predisposition Assessment (ATD PA), from a study done in the country Greece (Koumpouros et al. 2017; n=115). • Excellent interrater reliability (ICC=0.981, ranging from 0.973-0.987) • Adequate internal consistency (Cronbach's alpha =0.701, ranging from 0.605-0.701) • Adequate-Excellent construct validity for items in the Adaptablility subscale (r=0.537 to 0.783) • Excellent construct validity for items in the Fit to Use subscale (r= 0.691 to 0.801) • Adequate-Excellent construct validity for items in the Socializing (r= 0.498 to 0.767) • Low correlation coefficients between each subscale, indicating subscales measure unique constructs Improvements in person-centered assistive technology services and outcomes assessment are needed, given reports of a high level of dissatisfaction and nonuse of technology by consumers. It is important to ensure an evidence-based, client-centered assessment for determining the match of individuals with the most appropriate technologies for their use. Achieving a desired outcome begins at the point of technology consideration and then progresses to product selection. ABSTRACT Cognitive impairment often results in a range of functional and lifestyle changes for many individuals. This article discusses the development and evolution of a multidisciplinary model of cognitive rehabilitation outpatient practice that integrates technology to improve patient outcomes. The described interdisciplinary treatment approach highlights the need for collaboration by treating providers; focuses on the individual being an active participant in treatment; and discusses the value that assistive technology can bring to cognitive rehabilitation work as it relates to patient success, functional improvement, and implementation of appropriate and patient specific technological strategies.
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Objectives The study assessed a smartphone-based technology system, which was designed to enable six participants with intellectual disability and sensory impairment to start and carry out functional activities through the use of reminders and verbal or pictorial instructions. Methods The technology system involved a Samsung Galaxy A22 with Android 11 operating system and four Philips Hue indoor motion sensors. Three to five activities were scheduled per day. At the time at which an activity was due, the system provided the participant with a reminder followed by the verbal or pictorial instruction for the initial part of the first response (e.g., “Go to the bathroom and take the dirty towels”). The instruction would be available (repeated) until the participant responded to it and, in so doing, activated a sensor. Sensor activation caused the presentation of the instruction for the second part of the same (first) response (e.g., “Put the towels in the laundry machine”). The same process occurred for each of the responses involved in the activity. The system was introduced according to nonconcurrent multiple baseline designs across participants. Results During baseline, the mean percentage of activities the participants started independently was below 7; the mean frequency of correct responses per activity was below 0.5 (out of a maximum possible of 8). During the intervention (i.e., with the support of the technology system), the mean percentage and mean frequency values increased to nearly 100 and 8, respectively. Conclusions The data suggest that the aforementioned technology system may enable people with intellectual disability and sensory impairment to start and carry out functional activities independent of staff.
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Background: This study was an extension of research which began in the Umbria region in 2009. Aim: To investigate the extent to which assistive technology (AT) has been abandoned by users of the Italian National Health Service (ULHS) and the reasons for this. Design: Observational study. Setting: Users who received a hearing device (HD) or mobility device (MD) by ULHS between 2010 and 2013. Population: 749 out of 3,791 ULHS users contacted via telephone completed the interview: 330 (44.06%) had a HD and 419 (55.94%) a MD. Methods: Data were collected using a specially developed telephone interview questionnaire including the Italian version of the Quebec User Evaluation of Satisfaction with AT (QUEST 2.0) and Assistive Technology Use Follow-up Survey (ATUFS). Results: 134 users (17.9%) were no longer using their assigned AT device within seven months of issue and 40% of this group reported that they had never used the device. Duration of use (for how long the AT device was used before abandonment) and satisfaction with service delivery did not predict AT abandonment. People who received a HD where more likely to abandon their device (22.4%) than those who received a MD (14.4%). Conclusions: Abandonment may be due to assignment of inappropriate devices or failure to meet user needs and expectations. These findings are consistent with previous data collected by Federici and Borsci in 2009. Utility of AT in use, reasons of abandonment, and importance of device and service satisfaction for the use or non-use of an AT are presented and discussed. Clinical rehabilitation impact: AT abandonment surveys provide useful information for modelling AT assessment and delivery process. The study confirms the relevance of person centredness approach for a successful AT assessment and delivery process.
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Objective: This review examines the utility of current active, powered, wearable lower limb exoskeletons as aids to rehabilitation in paraplegic patients with gait disorders resulting from central nervous system lesions. Methods: The PRISMA guidelines were used to review literature on the use of powered and active lower limb exoskeletons for neurorehabilitative training in paraplegic subjects retrieved in a search of the electronic databases PubMed, EBSCO, Web of Science, Scopus, ProQuest, and Google Scholar. Results: We reviewed 27 studies published between 2001 and 2014, involving a total of 144 participants from the USA, Japan, Germany, Sweden, Israel, Italy, and Spain. Seventy percent of the studies were experimental tests of safety or efficacy and 29% evaluated rehabilitative effectiveness through uncontrolled (22%) or controlled (7%) clinical trials. Conclusions: Exoskeletons provide a safe and practical method of neurorehabilitation which is not physically exhausting and makes minimal demands on working memory. It is easy to learn to use an exoskeleton and they increase mobility, improve functioning and reduce the risk of secondary injury by reinstating a more normal gait pattern. A limitation of the field is the lack of experimental methods for demonstrating the relative effectiveness of the exoskeleton in comparison with other rehabilitative techniques and technologies.
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Background: Brain-computer interfaces (BCIs) allow persons with impaired mobility to communicate and interact with the environment, supporting goal-directed thinking and cognitive function. Ideally, a BCI should be able to recognize a user's internal state and adapt to it in real-time, to improve interaction. Objective: Our aim was to examine studies investigating the recognition of affective states from neurophysiological signals, evaluating how current achievements can be applied to improve BCIs. Methods: Following the PRISMA guidelines, we performed a literature search using PubMed and ProQuest databases. We considered peer-reviewed research articles in English, focusing on the recognition of emotions from neurophysiological signals in view of enhancing BCI use. Results: Of the 526 identified records, 30 articles comprising 32 studies were eligible for review. Their analysis shows that the affective BCI field is developing, with a variety of combinations of neuroimaging techniques, selected neurophysiological features, and classification algorithms currently being tested. Nevertheless, there is a gap between laboratory experiments and their translation to everyday situations. Conclusions: BCI developers should focus on testing emotion classification with patients in ecological settings and in real-time, with more precise definitions of what they are investigating, and communicating results in a standardized way.
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Background: Interdisciplinary cognitive rehabilitation is emerging as the expected standard of care for individuals with mild to moderate degrees of cognitive impairment for a variety of etiologies. There is a growing body of evidence in cognitive rehabilitation literature supporting the involvement of multiple disciplines, with the use of cognitive support technologies (CSTs), in delivering cognitive therapy to individuals who require cognitive rehabilitative therapies. This article provides an overview of the guiding theories related to traditional approaches of cognitive rehabilitation and the positive impact of current theoretical models of an interdisciplinary approach in clinical service delivery of this rehabilitation. Objective: A theoretical model of the Integrative Cognitive Rehabilitation Program (ICRP) will be described in detail along with the practical substrates of delivering specific interventions to individuals and caregivers who are living with mild to moderate cognitive impairment. The ultimate goal of this article is to provide a clinically useful resource for direct service providers. It will serve to further clinical knowledge and understanding of the evolution from traditional silo based treatment paradigms to the current implementation of multiple perspectives and disciplines in the pursuit of patient centered care. Methods: The article will discuss the theories that contributed to the development of the interdisciplinary team and the ICRP model, implemented with individuals with mild to moderate cognitive deficits, regardless of etiology. The development and implementation of specific assessment and intervention strategies in this cognitive rehabilitation program will also be discussed. Results: The assessment and intervention strategies utilized as part of ICRP are applicable to multiple clinical settings in which individuals with cognitive impairment are served. Conclusions: This article has specific implications for rehabilitation which include: (a) An Interdisciplinary Approach is an effective method for cognitive rehabilitation; and (b) Recent theories offer beneficial evaluation and intervention techniques for cognitive rehabilitation.
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Background: Assistive technology for cognition (ATC) can be an effective means of compensating for cognitive impairments following acquired brain injury (ABI). Systematic instruction is an evidence-based approach to training a variety of skills and strategies, including the use of ATC. Objective: This study experimentally evaluated systematic instruction applied to assistive technology for cognition (ATC) in a vocational setting. Methods: The study used a single-case, multiple-probe design across behaviors design. The participant was a 50-year old female with cognitive impairments following an acquired brain injury (ABI). As a part-time employee, she was systematically instructed on how to operate and routinely use selected applications (apps) on her iPod Touch to support three work-related skills: (a) recording/recalling the details of work assignments, (b) recording/recalling work-related meetings and conversations, and (c) recording/performing multi-step technology tasks. The experimental intervention was systematic instruction applied to ATC. The dependent measures were: (a) the use of ATC at work as measured by an ATC routine task analysis; and (b) recall of work-related tasks and information. Results: Treatment effects were replicated across the three work-related skills and were maintained up to one year following the completion of intensive training across behaviors with periodic review (booster sessions). Conclusions: Systematic instruction is a critical component to teaching the routine use of ATC to compensate for cognitive challenges following ABI.
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Background: Cognitive symptoms and other functional limitations associated with multiple sclerosis (MS) have a significant negative impact on employment status. Work accommodations positively impact the ability of a person with MS to obtain and retain employment, however, current understanding of the role of accommodations in the careers of adults with MS is limited. Objective: To analyze the percentage of American workers with MS who utilize workplace accommodations as per Title I of the ADA, the types of accommodations most frequently required, and differences in disease variables, job-related factors, and quality of life between workers using and not using work accommodations. Methods: Data from 746 employed adult members of the National MS Society surveyed about career concerns were analyzed. Descriptive and inferential statistics were used as appropriate to address the research questions. Results: Approximately 25% reported having requested accommodations, and 87.7% reported receiving the requested accommodation. Participants with progressive MS, cognitive impairment, higher number of MS symptoms and greater symptom severity were more likely to use work accommodations. Participants with accommodations reported poorer job match and career optimism than those using no accommodations. Conclusion: This large-scale analysis addresses several outstanding questions concerning work accommodations among workers with MS. Cognitive symptoms and disease severity are strongly associated with need for accommodations, however accommodations do not appear to promote job satisfaction or longevity. The accommodation request process and the impact of accommodations on employment retention remain important research foci.
Background: Specific Learning Disorders (SLD) therefore represent chronic, not temporary disorders with varying degrees of expression throughout life. The beginning of imaging, anatomy and genetics studies have made it possible to investigate the brain organization of individuals suffering from SLD (Deheane, 2009). Objectives: The purpose of this paper is to describe a treatment method for reading and writing disorders through an intervention based on the integration of a sublexical method and a neuropsychological approach, with assistive technologies in the study of a single case. Methods: The protocol is based on the modularization theory (Karmiloff-Smith, 1990). The data presented in this paper with a A-B-A basic experimental drawing. Results: This study confirms the degree of effectiveness of the treatments based on the automated identification of syllables and words together with the integrated enhancement of neuropsychological aspects such as visual attention and phonological loop (Benso, 2008), although in the follow-up condition only some abilities maintain the progress achieved. Conclusions: As previously mentioned, the SLD represents a chronic disorder, consequently the treatment does not solve the root cause of the problem, but can grant a use of the process decidedly more instrumental to everyday life.
Background: Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. Objective: This study aimed to (a) further assess a technology-aided approach for fostering MCS participants' responding and stimulation control and (b) carry out a social validation check about the approach. Methods: Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. Results: The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. Conclusions: A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.
Background: Many individuals with traumatic brain injury (TBI) are young and could have many years of productivity ahead of them. However, cognitive impairments may hinder individuals' ability to perform daily tasks. Assistive technology for cognition (ATC) can be effective in helping compensate for cognitive impairments. Objective: This study examined the current state of the research on using ATCs to support daily activities for individuals with cognitive disabilities that are due to TBI. Methods: A comprehensive systematic literature search was performed to identify peer-reviewed articles published between 2000 and 2015. To evaluate the nature of the research, qualitative data were extracted pertaining to recruitment, participant characteristics, intervention design, type of ATCs and their functions, matching individuals with ATCs, training for using the ATC, and outcomes. Results: Research examining the effectiveness of ATCs as everyday compensatory tools for cognitive impairments that are due to TBI is limited. The majority of studies were case studies or quasi-experimental studies with small sample sizes. Studies showed positive associations between use of ATCs and individuals' abilities to perform tasks regardless of age, TBI severity, and time since injury. Conclusions: Future research should assess the match between the individual and the technology, study the impact of training on using ATCs, and analyze the usability of ATCs.
Background: Project Career is an interprofessional five-year development project designed to improve the employment success of undergraduate college and university students with traumatic brain injury (TBI). The case study information was collected and synthesized by the project's Technology and Employment Coordinators (TECs) at each of the project's three university sites. The project's evaluation is occurring independently through JBS International, Inc. Objective: Five case studies are presented to provide an understanding of student participants' experiences within Project Career. Each case study includes background on the student, engagement with technology, vocational supports, and interactions with his/her respective TEC. Methods: A qualitative analysis from the student's case notes is provided within each case study, along with a discussion of the overall qualitative analysis. Results: Across all five students, the theme Positive Outcomes was mentioned most often in the case notes. Of all the different type of challenges, Cognitive Challenges were most often mentioned during meetings with the TECs, followed by Psychological Challenges, Physical Challenges, Other Challenges, and Academic Challenges, respectively. Conclusion: Project Career is providing academic enrichment and career enhancement that may substantially improve the unsatisfactory employment outcomes that presently await students with TBI following graduation.