Brain-In-Hand technology for adults with acquired brain injury: A convergence of mixed methods findings

Abstract

Introduction: Individuals with acquired brain injury may find it difficult to self-manage and live independently. Brain-in-Hand is a smartphone app designed to support psychological problems and encourage behaviour change, comprised of a structured diary, reminders, agreed solutions, and traffic light monitoring system.

Aim: To evaluate the potential use and effectiveness of Brain-in-Hand for self-management in adults with acquired brain injury.

Methods: A-B mixed-methods case-study design. Individuals with acquired brain injury (n = 10) received Brain-in-Hand for up to 12 months. Measures of mood, independence, quality of life, cognition, fatigue, goal attainment, participation administered at baseline, 6 and 12 months. Semi-structured interviews conducted with acquired brain injury participants (n = 9) and healthcare workers (n = 3) at 6 months.

Results: Significant increase in goal attainment after 6 months use (t(7) = 4.20, p = .004). No significant improvement in other outcomes. Qualitative data suggested improvement in anxiety management. Contextual (personal/environmental) factors were key in influencing the use and effectiveness of Brain-in-Hand. Having sufficient insight, appropriate support and motivation facilitated use.

Conclusions: Brain-in-Hand shows potential to support acquired brain injury, but further work is required to determine its effectiveness. Context played a pivotal role in the effectiveness and sustained use of Brain-in-Hand, and needs to be explored to support implementation.

Keywords: assistive technology; brain injury; independent living; rehabilitation; self-management; smart technology; smartphone app.

Figure 1.

Schematic of Brain-in-Hand system, from planning to data monitoring.

Figure 2.

Summary of International Classification of Functioning, Disability and Health (ICF) components for acquired brain injury (ABI).

Figure 3.

Recruitment diagram.

Figure 4.

Mean Goal Attainment Scale (GAS) scores with interquartile range and range at baseline, 6 months and 12 months post-intervention.

Figure 5.

Data exported from the Brain-in-Hand app showing the change in usage over time. Data presented from September 2016 (first case received intervention) to February 2018 (final case end of study). Support and frequent contact from research team reduced around 6 months (April 2017). Graph A: total number of users at a certain period of time that pressed at least one traffic light (monitoring fatigue or anxiety) shown in pink and those pressing at least one solution shown in blue; Graph B: total number of users at a certain time period that completed tasks on their BiH app shown in pink and total number of users that did not complete tasks shown in blue.

Figure 6.

Representation of the two elements necessary for the long-term implementation of technologies like Brain-in-Hand.