8. The BIRP Project

The Project

The project Implementing and evaluating Smart Phone Applications technology across the NSW Brain Injury Rehabilitation Program aims to:

• Provide web-based resources for clinicians
• Evaluation the efficacy of Smart Phone Apps for people with brain injury

  1. Does Smart Phone technology facilitate the setting and acquisition of client centred goals following a non-progressive acquired brain injury?
  2. Is smart phone technology a more time efficient therapy tool for therapists in a brain injury rehabilitation setting, as opposed to traditional devices?

The Project Coordinator is: Emma Charters, Speech Pathologist, Liverpool Health Service.

Acknowledgments

 The important contribution of Liverpool Hospital to this project is acknowledged, for convening the Working Party and for funding the project coordinator role undertaken by Emma Charters (Speech Pathologist).

 Acknowledgment is also extended to Dr Adeline Hodgkinson (Director, Brain Injury Rehabilitation Directorate) for supporting the project.

 The members of the Implementing and evaluating Smart Phone Applications technology across the NSW Brain Injury Rehabilitation Program (BIRP) Working Party are acknowledged for their expertise, advice and contributions to the project.

The Working Party

The Project Working Party includes:

Barbara Strettles: Brain Injury Rehabilitation Directorate Network Manager, Agency for Clinical Innovation
Emma Charters: Speech Pathologist; Liverpool Hospital, Sydney
Lauren Gillett: Neuropsychologist, Liverpool Hospital, Sydney
Grahame Simpson: Research Team Leader/Social Worker – Clinical Specialist, Liverpool Hospital, Sydney
Emma Power: Speech Pathologist/Post Doctorate Research Fellow, University of Sydney
Nathan Haywood: Speech Pathologist, Hunter Brain Injury Service
Rosa Ali: Neuropsychologist, Concord and Sydney Children’s Hospital

 

Background

TBI

Between 2004 and 2005, the Australian Institute of Health and Welfare (AIHW) Research & Statistics Series reported that over 22 000 Australians were hospitalised after sustaining a traumatic brain injury (TBI). Of these, falls, motor vehicle accidents and assaults were the highest incidents leading to a hospital admission . Helps, Henley and Harrison (2008) identified that males who are aged between 15-24 and 80-85 were at a higher risk of sustaining a TBI. The AIHW also note that of these admissions, almost 12 000 required ongoing services specialising in TBI.

A TBI can lead to changes relating to a person’s physical, psychological, cognitive and communication abilities. These changes have implications for the person’s family, friends, caregivers and the community at large. Costly and lengthy hospital admissions, extensive post hospital care and difficulty carrying out their premorbid roles and responsibilities are examples of the economic and social implications following a TBI . In addition to these, individual impairments such as physical strength and coordination, cognitive, communication, memory and executive functioning difficulties can lead to difficulty initiating simple routines such as self care, taking medications, recalling their medical history or following through with recommendations made by health care professionals.

Smart phones

In recent years, the range of technological devices that are available to assist with everyday activities have expanded rapidly. In particular, the Smart Phone varieties provide a handheld device which functions as a telephone, internet service and has multiple applications available for download. Clinicians in health care settings have begun to use this technology to assist their clients with a range of individualised therapy tasks .

Recent literature (including studies carried out in 2008 by Schoenberg et al and Thorton et al) have shown that a Smart Phone has the ability to compensate for executive functioning and communication impairments where traditional devices have been unsuccessful. Participants have been trialled using a Smart Phone to replace traditionally recommended devices such as alarm clocks, calendars and verbal prompting from a caregiver. To date, functional improvements following the implementation of a Smart Phone into a client’s management plan have included improved recall, initiation of a target behaviour or goal, planning and organisation skills (Wright et al 2001, Blackstone et al, 2007 and Kennedy et al 2008).

Trials

In practice, clinicians specialising in brain injury rehabilitation across the Sydney Metropolitan Area have started trials with various types of Smart Phones and applications. These clinicians have reported that a Smart Phone can successfully prompt activities of daily living, record important details, provide a means of communication across a range of modalities and facilitates the storage of a large amount of information in a secure location. For many patients this tool has replaced their need for multiple tools which are not age or socially acceptable, with a single portable device able to be used in a range of environments.

Pilot study

A pilot study has been carried out in Liverpool Brain Injury Rehabilitation Unit (BIRU) at Liverpool Hospital. Five single study case trials were completed with patients admitted to Liverpool BIRU in 2010. In each of these cases, the Smart Phone facilitated the interdisciplinary and patient centred goal setting in order to attain effective therapeutic and compensatory outcomes. Outcomes included; improved communication, executive functioning skills, and completion of activities of daily living and increased compliance with physiotherapy recommendations.

The reasons behind the preliminary success of the smart phone as opposed to traditional devices are likely to vary significantly between individuals. They may include one or more of the following;

• Multi-purpose, socially acceptable and age acceptable
• Features which can compensate for motor and sensory impairment (e.g. vision, hearing, limb weakness or in-coordination)
• Large storage capacity which can be synchronised to an external hard-drive
• Easily update to address the changing needs of the individual
• Repetitive use giving opportunity for errorless learning of daily routine
• Cost effective.