NeuroRehabilitation - Volume 28, issue 3

Authors: Ruff, Ronald M.

Article Type: Research Article

Abstract: A debate exists concerning whether a mild traumatic brain injury (MTBI) can cause permanent brain-based residuals. This debate is examined by reviewing meta-analytic studies that found no significant effect sizes between large samples of patients with and without MTBI at three months post-accident. In contrast, research studies with MTBI patients have captured cognitive deficits corroborated by positive neuroimaging, which supports the viewpoint that brain-based postconcussive disorders likely exist in a small minority of individuals. Ongoing hurdles that likely contribute to this debate are identified. This includes the lack of agreed upon definitions; substantial differences exist between the ICD-10 definition for …Postconcussion Syndrome and the DSM-IV-TR definition for Postconcussional Disorder. Confining the debate to brain-based versus psychologically-based viewpoints results in a false dichotomy. Instead, a more refined sub-classification of the postconcussive complex is proposed that captures different constellations across the physical, emotional, and cognitive symptoms complex. Moreover, this diagnostic framework attempts to expand discipline-based approaches with a patient-based understanding. Show more

DOI: 10.3233/NRE-2011-0646

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 167-180, 2011

Authors: Gentry, Tony

Article Type: Editorial

DOI: 10.3233/NRE-2011-0647

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 181-182, 2011

Authors: Burgstahler, Sheryl | Comden, Dan | Lee, Sang-Mook | Arnold, Anthony | Brown, Kayla

Article Type: Research Article

Abstract: Computers, telephones, and assistive technology hold promise for increasing the independence, productivity, and participation of individuals with disabilities in academic, employment, recreation, and other activities. However, to reach this goal, technology must be accessible to, available to, and usable by everyone. The authors of this article share computer and telephone access challenges faced by individuals with neurological and other impairments, assistive technology solutions, issues that impact product adoption and use, needs for new technologies, and recommendations for practitioners and researchers. They highlight the stories of three individuals with neurological/mobility impairments, the technology they have found useful to them, and their …recommendations for future product development. Show more

Keywords: Technology, access, computer use

DOI: 10.3233/NRE-2011-0648

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 183-197, 2011

Authors: Wallace, Tracey | Bradshaw, Adina

Article Type: Research Article

Abstract: Communication problems experienced following a brain injury or stroke not only impact a person's ability to participate in their desired social and vocational roles but may also impact their ability to participate in decision-making about their care, participate in therapy and receive counseling and education. Many technologies exist, including Augmentative and Alternative Communication (AAC), which can help increase communication and life participation following a brain injury or stroke. This article will define and describe a variety of AAC technologies and interventions for people with communication problems following acquired brain injury as well as discuss assessment, training and funding issues.

Keywords: AAC, Augmentative and Alternative Communication, communication aids, treatment, strategies, rehabilitation, technologies, brain injury, stroke

DOI: 10.3233/NRE-2011-0649

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 199-209, 2011

Authors: Copolillo, Al | Ivanoff, Synneve Dahlin

Article Type: Research Article

Abstract: People with neurovisual deficits from acquired brain injuries and other neurological disabilities can benefit from the array of assistive technologies and home modifications available to the larger vision impairment population, especially when symptoms are mild and associated neurological conditions are few. Optics, proper lighting, and magnification to increase the perceived size of both objects and reading material and to improve contrast sensitivity have been shown to be beneficial. Innovative technologies, universally designed for safe independent living and community participation are gradually developing and show promise for addressing the needs of this population. This article highlights technologies that may be useful …for people with neurovisual deficits and describes the evidence to support their training and use. The use of various types of eyewear to reduce falls; prisms and telescopic lenses to improve visual attention and minimize the impact of visual field deficits; and technologies to improve computer use, wayfinding, and home safety are discussed. While there remains substantial need for further research and development focusing on the needs of people with vision impairments from neurological conditions, practitioners can use technology with caution to improve functional outcomes. Show more

Keywords: Assistive technology, low vision, rehabilitation, self-help devices, vision disorders

DOI: 10.3233/NRE-2011-0650

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 211-220, 2011

Authors: Lane, Amy K. | Benoit, Dana

Article Type: Research Article

Abstract: Individuals with brain injury often present with cognitive, physical and emotional impairments which impact their ability to resume independence in activities of daily living. Of those activities, the resumption of driving privileges is cited as one of the greatest concerns by survivors of brain injury. The integration of driving fundamentals within the hierarchical model proposed by Keskinen represents the complexity of skills and behaviors necessary for driving. This paper provides a brief review of specific considerations concerning the driver with TBI and highlights current vehicle technology which has been developed by the automotive industry and by manufacturers of adaptive driving …equipment that may facilitate the driving task. Adaptive equipment technology allows for compensation of a variety of operational deficits, whereas technological advances within the automotive industry provide drivers with improved safety and information systems. However, research has not yet supported the use of such intelligent transportation systems or advanced driving systems for drivers with brain injury. Although technologies are intended to improve the safety of drivers within the general population, the potential of negative consequences for drivers with brain injury must be considered. Ultimately, a comprehensive driving evaluation and training by a driving rehabilitation specialist is recommended for individuals with brain injury. An understanding of the potential impact of TBI on driving-related skills and knowledge of current adaptive equipment and technology is imperative to determine whether return-to-driving is a realistic and achievable goal for the individual with TBI. Show more

Keywords: Driving, brain injury, assistive technology

DOI: 10.3233/NRE-2011-0651

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 221-229, 2011

Authors: Gater Jr., David R. | Dolbow, David | Tsui, Britney | Gorgey, Ashraf S.

Article Type: Research Article

DOI: 10.3233/NRE-2011-0652

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 231-248, 2011

Authors: Dewsbury, Guy | Linskell, Jeremy

Article Type: Research Article

Abstract: This paper proposes that people with neurological conditions can be successfully supported by smart homes only when their needs and aspirations of the technological interventions are fully understood and integrated in the design. A neurological condition can and does provide a clue to the finished technological design but this alone fails to personalise the system and stands to be rejected by the person who requires the technology. This paper explores the underlying issues of the complexity of this design process when designing for people with neurological conditions, and advances a matrix to facilitate the assessment process to maintain …a person-centred design of any system. Show more

Keywords: Smart Home, technology, United Kingdom

DOI: 10.3233/NRE-2011-0653

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 249-260, 2011

Authors: Stock, Steven E. | Davies, Daniel K. | Wehmeyer, Michael L. | Lachapelle, Yves

Article Type: Research Article

Abstract: The concept of community access is a multidimensional term, which may involve issues related to physical access, knowledge and information, power and control, relationships and communications, advocacy, participation and quality of life [21]. This paper discusses historical and emerging practices and interventions related to physical access to community and community based information for individuals with cognitive disabilities such as intellectual disability, autism or traumatic brain injury. While much societal attention has been paid to features of independent community access for populations such as individuals with hearing, vision or physical disabilities, less attention has focused on independent community access for people …with intellectual and other significant cognitive disabilities. Attitudes and actions by families and professional service communities are often mixed for some individuals in this population. The somewhat limited research base in these areas is explored, including a case study review and results from several promising feasibility studies. The paper concludes with comments concerning future prospects and recommendations for improving independent community access for persons with significant cognitive disabilities. Show more

Keywords: Intellectual and cognitive disabilities, technology, community access

DOI: 10.3233/NRE-2011-0654

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 261-269, 2011

Authors: Boger, Jennifer | Mihailidis, Alex

Article Type: Research Article

Abstract: A person's ability to be independent is dependent on his or her overall health, mobility, and ability to complete activities of daily living. Intelligent assistive technologies (IATs) are devices that incorporate context into their decision-making process, which enables them to provide customised and dynamic assistance in an appropriate manner. IATs have tremendous potential to support people with cognitive impairments as they can be used to support many facets of well-being; from augmenting memory and decision making tasks to providing autonomous and early detection of possible changes in health. This paper presents IATs that are currently in development in the research …community to support tasks that can be impacted by compromised cognition. While they are not yet ready for the general public, these devices showcase the capabilities of technologies one can expect to see in the consumer marketplace in the near future. Show more

Keywords: Intelligent assistive technology (IAT), cognition support, smart homes, independent living, aging with choice

DOI: 10.3233/NRE-2011-0655

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 271-280, 2011

Authors: Casey, Kelly Showalter

Article Type: Research Article

Abstract: For persons with Amyotrophic Lateral Sclerosis (ALS), comprehensive multidisciplinary care can effectively improve overall quality of life from diagnosis to end of life [16]. Considering the rapidly progressive loss in overall function experienced by persons with ALS, it is essential to provide comprehensive multidisciplinary care, including Assistive Technology (AT) services, in an effective and efficient manner. AT is an important adjunctive therapy for people with neurological disability. For people with complex conditions, access to a comprehensive AT clinic can be the best way to access these tools. Unfortunately, few medical centers have invested in AT clinics, and managers may not …understand how to go about developing AT resources at their facility. This article chronicles the step-by-step development of The Johns Hopkins Assistive Technology Clinic for persons with ALS. It offers background evidence, the process of program development, and insight into the experience of professional accountability of one occupational therapist turned AT Director. It also details descriptions of the stakeholders and their roles in the development process, funding and ethical considerations, and barriers to implementation. It is hoped that this may provide guidance for teams who may wish to build AT facilities in their own practice settings. Show more

Keywords: Amyotrophic Lateral Sclerosis (ALS), assistive technology, occupational therapy, speech-language pathology, multidisciplinary clinic

DOI: 10.3233/NRE-2011-0656

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 281-293, 2011

Authors: Wallace, Joseph

Article Type: Research Article

Abstract: The funding of assistive technology (AT) in the United States falls within a complex web of traditional and non-traditional funding sources that often create challenging barriers for individuals with disabilities. This article outlines the founding policies that drive the federal and state funding of AT across insurance, education, rehabilitation sectors and beyond. A presentation of specific medical and non-medical funding options is discussed addressing eligibility, types of AT covered and general program characteristics. I conclude with recommendations for the pursuit of AT funding in light of these policies and options.

Keywords: Assistive technology, funding, assistive technology policies, best practices

DOI: 10.3233/NRE-2011-0657

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 295-302, 2011

Authors: Bartfai, Aniko | Boman, Inga-Lill

Article Type: Research Article

Abstract: The purpose of this paper is to describe policies, laws and regulations regarding the procurement of assistive technology and home modifications for individuals with disabilities in Sweden. Children up to ages 17–21 are entitled to free access to assistive technology. For adults the access is substantially subsidized with public funding. We will discuss the issues and implications of new technology, with an emphasis on assistive technology for cognitive impairment. Today, the social security system is financially burdened due to increasing demands and limited economic growth. However, the basic doctrine of the “Swedish model” remains, evoking structural and ethical issues.

Keywords: Assistive technology, home modification, disability, cognitive impairment, reimbursement policies, “Swedish model”

DOI: 10.3233/NRE-2011-0658

Citation: NeuroRehabilitation, vol. 28, no. 3, pp. 303-308, 2011