Electronic reminding technology following traumatic brain injury: effects on timely task completion.

OBJECTIVE: To determine whether automated reminders from 2 contemporary personal digital assistant (PDA) devices produce higher rates of timely task completion in people with traumatic brain injury (TBI). SETTING: Outpatient and community rehabilitation settings. PARTICIPANTS: Thirty-six adults aged 18 to 66 years with TBI and self-determined complaints of memory impairment. MEASURES: Timely completion rates for assigned memory tasks under 4 randomly assigned memory aid conditions. RESULTS: Significantly, higher completion rates were found when using either PDA device when compared with a combined baseline and paper memory aid condition (for Palm OS device, Incidence Rate Ratio [IRR] = 2.14, P < .0005, CI [confidence interval] = 1.77-2.59; for Microsoft Pocket PC OS device, IRR = 1.47, P < .001, CI = 1.18-1.82). A significant difference in completion rates was also found between the 2 PDA devices (IRR = 1.46, P < .0005, CI = 1.26-1.70), with the Palm version producing the better scores. CONCLUSIONS: Substantially higher rates of task completion (more than double in some cases) when using either PDA device suggest that rehabilitation clinicians can make productive use of PDA-based memory aids in their TBI patient populations. The strength of the effects of PDA device usage argues for further investigation of the impact of device usage on quality-of-life and costs of care, and of personal and caregiver factors predictive of successful and sustained device usage.

Clinical supervision of a client with traumatic brain injury in a host home placement using video teleconferencing: a case study.

OBJECTIVE: To examine the use of video teleconferencing (VTC) technology in the supervision of a 41-year-old man with expressive aphasia during community reintegration in a host home setting 3 years after severe traumatic brain injury (TBI). DESIGN: Using a 3-month A-B-A design, weekly VTC meetings were substituted for in-person visits by the client's case coordinator. MAIN OUTCOME MEASURES: Weekly ratings of satisfaction with the medium of communication used (VTC vs in-person meetings) by each participant. RESULTS: The client and the case coordinator found VTC meetings to be as effective as face-to-face supervision visits for communication of clinical concerns and problems. The client reported feeling self-conscious about having the equipment in his living space because of privacy concerns. The mentor reported that VTC helped focus on questions and answers in goal-oriented conversations, was easier to schedule, and had the advantage of not requiring preparation of the house for in-person meetings. Reported disadvantages included feelings of camera shyness as well as impatience due to slow video transmission speed at times. The case coordinator also found VTC meetings easier to schedule and reported savings in travel time and expense. Reported disadvantages included reduced transmission quality and speed on some occasions. The cost break-even point for VTC was reached at 1 year with substitution of VTC sessions for half of weekly case coordinator home visits and 2 home visits per year by the coordinator's supervisor. CONCLUSION: VTC might be liberally substituted for in-person supervision visits in the context of an ongoing clinical relationship during community reintegration following TBI.