A Lindén's research while affiliated with Skåne University Hospital and other places

To investigate how individualised occupation-based interventions with commonly available everyday technology (ET) can compensate for perceived difficulties with daily life tasks after an aquired brain injury (ABI) and improve satisfaction with occupational performance. This intervention study was designed as a multiple case study according to Yin. Ten men and women with an ABI (traumatic or non-traumatic) participated. Data were collected through interviews, observations and field notes before and after the intervention and at follow-up (on average 11 weeks afterwards). The interventions focused on enabling each participant's prioritised goals related to task performance in daily life. All participants achieved all their goals by learning to use both new functions in their own familiar ET and new ET. The participant's perceived difficulties in occupational performance decreased and their satisfaction with occupational performance increased with the use of ET. An individualised intervention process, involving the use of own familiar ET or ET off-the-shelf, has the potential to compensate for perceived difficulties following an ABI and improve satisfaction with occupational performance in daily life.

Using everyday technology (ET) is a prerequisite for activities and participation at home and in the community. It is well known that persons with an acquired brain injury (ABI) can have limitations in activities of daily living but our knowledge of their difficulties using ET is not known. Thirty-six persons (27 men and 9 women, mean age 44 years, age range 26-60) with an ABI (2-10 years post injury) were interviewed, using the Everyday Technology Use Questionnaire (ETUQ), about their perceived difficulties using ET and how these difficulties influenced their everyday activities and their possibilities to participate at home and in the community. A majority (78%) of the persons reported difficulties using ET. The most common difficulties were related to the use of telecommunication and computers. Despite these difficulties, a majority still used most objects and services independently. Twenty-six participants (72%) perceived that their difficulties using ET influenced their everyday activities and their possibility to participate at home and in the community. The results indicate that rehabilitation following an ABI should consider whether clients' use of ET influences their activity and participation and adopt interventions accordingly. The results also indicate that difficulties using ET need to be considered in the design of community services to prevent societal barriers.

Memory disturbance, deficient concentration, and fatigue are symptoms seen in amnestic mild cognitive impairment (MCI) as well as in mild traumatic brain injury (TBI). The aim of this study was to assess if an established rehabilitation program commonly used in TBI can aid MCI patients to develop compensatory memory strategies that can improve their cognition, occupational performance, and quality of life (QoL). Fifteen patients with MCI participated in the program 2 days per week for 8 weeks. Cognitive function, occupational performance, and self-perceived QoL were assessed at baseline, at the end of the intervention, and at follow-up after 6 months. Significant improvements were seen in cognitive processing speed, occupational performance, and in some of the QoL domains. As this goal-oriented rehabilitation program in MCI resulted in some improvements in cognition, occupational performance, and QoL, further randomized controlled studies are warranted.

It is speculated that virtual environments (VE) might be used as a training tool in brain injury rehabilitation. The rehabilitation process often involves practicing so- called instrumental activities of daily living (IADL), such as shopping, cooking, and using a telephone. If a brain injury patient is to practice such activities in a VE, the patient must be able to navigate the viewpoint and interact with virtual objects in an understandable way. People with brain injury may be less tolerant to a poor interface and a VE might therefore become unusable due to, for example, an un- suitable input device. In this paper we present two studies aimed to do initial us- ability testing of VE interaction methods on people without experience of 3D com- puter graphics. In the first study four navigation input device configurations were compared: the IntelliKeys keyboard and the Microsoft Sidewinder joystick, both pro- grammed with two and three degrees of freedom (DOF). The purpose of the sec- ond study was to evaluate a method for interaction with objects, and to find a suf- ficiently usable input device for this purpose. The keyboard was found to be more suitable for navigation tasks in which the user wants to give the viewpoint a more advantageous position and orientation for carrying out a specific task. No big differ- ences could be found between two and three DOFs. The method for interaction with objects was found to work sufficiently well. No difference in performance could be found between mouse and touch screen, but some evidence was found that they affect the usability of the VE interface in different ways.

To compare recovery of cognitive functions and activities of daily living during the first year of rehabilitation after severe brain trauma. Sixteen patients were evaluated by neuropsychological tests and occupational performance (assessment of motor and process skills, AMPS) on admission to the rehabilitation centre and 3, 6 and 12 months later. Cognitive functions improved continuously. Motor skills recovered rapidly and were relatively stable after 3 months. For process skills recovery was protracted. Six of 15 patients were still below the cut-off level after 12 months. Eleven of 13 patients deteriorated regarding process skills after leaving the rehabilitation centre. AMPS gives a different view of the patient's restitution than neuropsychological tests and may be a better indicator of the patients' ability to resume independent living. The deterioration of process skills post-rehabilitation suggests that lasting contact in an outpatient setting might facilitate return to social life.

Two different approaches for developing virtual environments (VE) for brain injury rehabilitation are described and discussed. The two VEs are built with the VR software World Up in the form of virtual vending and automatic service machines. The result from the first approach is a virtual cash dispenser that has been tested on five patients with brain injury. Improving the VE according to the test results was found to be quite hard, since it is implemented in a way that makes it difficult to update the code. In the second approach independent programming modules were identified and isolated. The modules were used to build a VE in the form of a train ticket machine. The second approach seems to provide a fast and understandable way of building virtual vending and automatic service machines for brain injury rehabilitation. There might also be the possibility to add a graphical user interface on top of the modules so that, for example, an occupational therapist with no programming experience could build an arbitrary virtual vending machine.

To determine whether neuropsychological outcome is related to cerebral blood flow (CBF) early in the recovery phase. Twelve consecutive patients (mean age of 30 years, range 15-48 years) with severe traumatic brain injuries were subjected to a neuropsychological test battery at admission to the rehabilitation unit and after 3, 6 and 12 months. CBF measurements were performed at admission and 6 and 12 months later with a high-resolution, two-dimensional regional cerebral blood flow system with 254 stationary detectors after 1 min of (133)Xe inhalation (70-100 MBq/l). Mean CBF values were within normal range already in the early post-acute phase and remained virtually unchanged during the first year of rehabilitation. A correlation was found between the individual CBF level and neuropsychological outcome 1 year after injury, particularly with regard to verbal memory capacity, reasoning capacity, and information processing speed.

Virtual Reality (VR) as a complementary tool for medical practitioners in the assessment and rehabilitation of people who have suffered a brain injury is discussed. A pilot-study has been undertaken on a prototype VR assessment tool. The design involved nine occupational therapists with expertise in the care of traumatic brain-injured patients and one (computer experienced) patient. The aim was to begin a dialogue and to ascertain the potential of a VR system. A common method for occupational therapists to assess function and ability is to ask a patient to brew coffee. From the performance of such a task, an individual's "functional signature" can be determined. The prototype was built using Superscape ® , a personal computer based VR system, to be close to the real coffee making task, including effects of making mistakes, realistic graphics and sound effects. The world was designed to be as easy to use and intuitive as possible, though problems of mental abstraction level, transfer of training and realistic interaction have yet to be resolved. The comments from the test participants have highlighted problem areas, given positive insight and pointed out other scenarios where VR may be of use in the rehabilitation of people with a traumatic brain injury.

Part of the process of rehabilitation after a brain injury is the relearning of various daily tasks such as preparing food, managing finances, getting from one place to another and so forth. These tasks require learning on all levels from physical to cognitive. Remembering a PIN code for a bank card, for example, can become automatic and 'in the fingers' after much repetition. However, other tasks require a certain cognitive process, for example, procedures must be followed, quantities estimated, numbers of items remembered or dangerous situations avoided. Even in these cases, repetition of the task many times can help fix the important aspects in the mind. This paper describes three applications of a Virtual Reality based method of rehabilitation which are a part of a larger project to investigate the potential and pitfalls of Virtual Reality technology as a complement to physical training in Brain Injury Rehabilitation. Virtual Reality has the advantage of providing a safe, controlled and highly repeatable environment that a patient can experience in a relaxed manner before having to encounter the potentially dangerous or stressful real environment. The three applications considered here are: kitchen work, an automatic teller machine (ATM) and finding ones way in a complex environment.