The use of everyday technology in occupational therapy practice for clients with acquired brain injury

The purpose of this descriptive study was to investigate how occupational therapists use everyday technology (ET) in their evaluation and treatment of adults with acquired brain injury (ABI). Questions included (1) the type of client therapists believed most likely to benefit from using technology, (2) current patterns of technology use with clients, including type of technology and frequency of use (3) the extent to which therapists think ET was effective, and (4) the supports for and barriers against using ET in practice. A survey was completed by 40 occupational therapists who were members of the Physical Disabilities, Technology, or Home and Community Health Special Interest Sections (SIS) of the American Occupational Therapy Association (AOTA). The findings indicated that occupational therapists tend not to ask questions about ET, evaluate its use formally or informally, may make assumptions about client’s ability to use ET, and not consider work related interventions. Many clinicians report ET to be useful, but tend not to use it in practice, possibly due to barriers impacting therapists’ use of ET, such as, access to and knowledge about ET. ET use should be considered in the future development of standardized assessments, occupational therapy education, and research. THE USE OF EVERYDAY TECHNOLOGY 3 The use of everyday technology in occupational therapy practice for clients with acquired brain injury An acquired brain injury (ABI) can be a result of conditions such as a stroke or a traumatic brain injury (TBI). Strokes are the leading cause of severe, long-term disability in the U.S. (American Stroke Association, 2014) and TBI is the leading cause of disability in adults under 44 years of age (Brain Trauma Foundation, n.d.). In 2010, 2.5 million individuals experienced a TBI (Centers for Disease Control and Prevention, 2014) and approximately 800,000 people experience a stroke each year (American Heart Association, 2013). Individuals with ABI often experience difficulties performing everyday tasks due to cognitive limitations (Bar-Haim Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir, 2009; Powell, Temkin, Machamer, & Dikmen, 2007). Occupational therapy (OT) has the potential to help individuals with ABI increase their participation in everyday tasks through interventions focused on cognition. Interventions are ultimately focused on improving a client’s engagement in occupations, including ADL, IADL, rest and sleep, education, work, leisure, and social participation (American Occupational Therapy Association [AOTA], 2014a). One tool that can be used to help individuals with ABI complete everyday tasks and participate in their chosen occupations is everyday technology (ET). ET includes high tech devices commonly used by the general population, such as smartphones, tablets, and computers. Individuals with ABI may be able to specifically benefit from the use of these devices. Given that 75% of households in the U.S. reported having a computer in 2011 (File & Ryan, 2014), 58% of adults in the U.S. have a smartphone, and 42% of adults in the U.S. own a tablet computer (Pew Research Internet Project, 2014), utilizing the technology in an individual’s THE USE OF EVERYDAY TECHNOLOGY 4 current life as part of OT intervention may be an inexpensive and easily accessible solution to help those with ABI compensate for cognitive deficits. The first step for therapists when designing intervention plans is to evaluate the current status of the client. ET can be integrated into OT evaluations in several ways, including asking questions about ET during the occupational profile, examining occupational performance using ET (M. B. Holm, personal communication, January, 2014), as well as specifically assessing a client’s ability to manage ET (Malinowsky, Nygård, & Kottorp, 2011). ET can also be incorporated into individualized occupation-based interventions as a method of improving the occupational performance and satisfaction of individuals with ABI (Lindén, Lexell, & Larsson Lund, 2011). To successfully incorporate ET into the OT process, occupational therapists need to employ activity analysis and evaluate the fit between the person, task, and ET selected (Covington & Kim, 2014; Engstrom, Lexell, & Larsson Lund, 2010; Larsson Lund, Nygard, & Kottorp, 2014). Occupational therapists may need to provide extensive and prolonged support to train individuals with severe memory impairments how to use ET (Boman, Lindberg-Stenvall, Hemmingsson, & Bartfai, 2010). This suggests that the effectiveness of ET may be contingent on the severity of the cognitive difficulties (Boman et al., 2010), the fit between the person’s abilities and the demands of the technology (Covington & Kim, 2014; Engstrom et al., 2010; Larsson Lund et al., 2014), the ability of the therapist to correctly match the person with the technology (Covington & Kim, 2014), and the amount of support the occupational therapist is able to provide (Boman et al., 2010). Very little is known about how therapists make decisions regarding the use of ET with individuals with ABI and the factors that influence that decision making. It is necessary to gain a greater understanding of occupational therapists’ clinical reasoning when using ET in practice. THE USE OF EVERYDAY TECHNOLOGY 5 This includes discovering the reasons why occupational therapists choose to use or not use ET in practice with individuals who have ABI, how ET is currently used in OT evaluations and interventions, the extent to which therapists think ET is useful, and the barriers and supports therapists may encounter when using ET in practice. Understanding the occupational therapists’ clinical reasoning may also provide insight into how the use of ET is relevant or irrelevant to the skills the occupational therapists address with their clients. Considering that ET has the potential to positively influence the lives of people with ABI (Lindén et al., 2011), research investigating the current use of ET in OT practice can fill a gap in current literature. Prior research has only focused on the therapist’s perspective of specialized technology or ET used in conjunction with specialized technology (Chen & Bode, 2011; Hart, O’Neil-Pirozzi, & Morita, 2003), which suggests that further research is needed in regards to the occupational therapist perspective of ET used on its own. A recent qualitative study at the University of Puget Sound was completed on the perspectives of occupational therapists who were experts on the use of ET with clients with brain injury (Covington & Kim, 2014). Comparing the findings from that study with a larger sample would help inform the profession about clinical practice in this important area.