Till Örebro universitet

BACKGROUND: Digital assistive technology (DAT) may support time management in people with dementia or mild cognitive impairment (MCI), but research on DAT for time management is limited. We aimed to explore how everyday could be supported by DAT for time management in persons with dementia or MCI from informal carers' perspectives. This study focused on a DAT device for time management called MEMOplanner (MMP).

METHOD: Using a mixed-methods design, we utilized the Time-Proxy© questionnaire and a study-specific interview guide to investigate the perspectives of informal carers (n = 8) regarding the use of MMP by individuals with dementia or MCI.

RESULT: The MMP was helpful in keeping track of time and activity. It helped to maintain an active lifestyle and facilitated communication. However, the MMP did not reduce the need for assistance from the informal carers, and it took time to learn the different functions of the device. Further research into employing a more extensive array of DAT for time management or other areas to assist individuals with dementia will yield valuable insights into enhancing and sustaining a higher quality of life despite cognitive decline.

Background: A valid and reliable tool is crucial for municipal registered nurses (RNs) to make quick decisions in older adults who show rapid signs of health deterioration. The aim of this study was to investigate the psychometric properties of the Decision Support System (DSS) among older adults in the municipal healthcare system.

Methods: Firstly, we utilized the Rasch dichotomous model to analyze the DSS assessments (n=281) that were collected from municipal RNs working with older adults in the municipal healthcare system. We examined the properties of the DSS in terms of its unidimensionality, item fit, and separation indices. Secondly, to investigate inter-rater agreement in using the DSS, four experienced municipal RNs used the DSS to assess 60 health deterioration scenarios presented by one human patient simulators. The 60 DSS assessments were then analyzed using the ICC (2,1), percentage agreement, and Cohen kappa statistics.

Results: The sample of older adults had a mean age of 82.8 (SD 11.7). The DSS met the criteria for unidimensionality, although two items did not meet the item fit statistics when all the DSS items were analyzed together. The person separation index was 0.47, indicating a limited level of separation among the sample. The item separation index was 11.43, suggesting that the DSS has good ability to discriminate between and separate the items. At the overall DSS level, inter-rater agreements were good according to the ICC. At the individual DSS item level, the percentage agreements were 75% or above, while the Cohen kappa statistics ranged from 0.46 to 1.00.

Conclusions: The Rasch analysis revealed that the psychometric properties of the instrument were acceptable, although further research with a larger sample size and more items is needed. The DSS has the potential to assist municipal RNs in making clinical decisions regarding health deterioration in older adults, thereby avoiding unnecessary emergency admistion and helping.

BACKGROUND: Eye tracking technology not only reveals the acquisition of visual information at fixation but also has the potential to unveil underlying cognitive processes involved in learning to use a multifunction prosthetic hand. It also reveals gaze behaviours observed during standardized tasks and self-chosen tasks. The aim of the study was to explore the use of eye tracking to track learning progress of multifunction hands at two different time points in prosthetic rehabilitation.

METHODS: Three amputees received control training of a multifunction hand with new control strategy. Detailed description of control training was collected first. They wore Tobii Pro2 eye-tracking glasses and performed a set of standardized tasks (required to switch to different grips for each task) after one day of training and at one-year-follow-up (missing data for Subject 3 at the follow up due to socket problem). They also performed a self-chosen task (free to use any grip for any object) and were instructed to perform the task in a way how they would normally do at home. The gaze-overlaid videos were analysed using the Tobii Pro Lab and the following metrics were extracted: fixation duration, saccade amplitude, eye-hand latency, fixation count and time to first fixation.

RESULTS: During control training, the subjects learned 3 to 4 grips. Some grips were easier, and others were more difficult because they forgot or were confused with the switching strategies. At the one-year-follow-up, a decrease in performance time, fixation duration, eye-hand latency, and fixation count was observed in Subject 1 and 2, indicating an improvement in the ability to control the multifunction hand and a reduction of cognitive load. An increase in saccade amplitude was observed in both subjects, suggesting a decrease in difficulty to control the prosthetic hand. During the standardized tasks, the first fixation of all three subjects were on the multifunction hand in all objects. During the self-chosen tasks, the first fixations were mostly on the objects first.

CONCLUSION: The qualitative data from control training and the quantitative eye tracking data from clinical standardized tasks provided a rich exploration of cognitive processing in learning to control a multifunction hand. Many prosthesis users prefer multifunction hands and with this study we have demonstrated that a targeted prosthetic training protocol with reliable assessment methods will help to lay the foundation for measuring functional benefits of multifunction hands.

BACKGROUND: COVID-19 has presented many difficulties in providing person-centred care (PCC) in nursing homes (NH). Factors such as organisational support, work condition and leadership may play a crucial role in supporting the performance of PCC during COVID restrictions. The study aim was to evaluate nursing staff and manager perceptions of the opportunities to perform person-centred care during the COVID-19 pandemic.

METHODS: Nursing staff (NS) (n = 463) and First Line Managers (FLM) (n = 8) within all NHs in one community filled in the SVENIS questionnaire which consists of five areas: perceived organizational support, work climate, person-centred care, work conditions and leadership. A Kruskal-Wallis test was used to perform inter-group comparisons and standard multiple regression was used to investigate which factor contributed most to perform PCC.

RESULTS: The comparison analyses indicate that staff from nursing homes for persons with dementia had the highest opportunities to perform PCC during the pandemic. The day shift staff had more opportunities to perform PCC than night shift staff. The results from the standard multiple regression show that a NA's current nursing home was the most significant variable affecting the opportunities to perform PCC. The analyses of both the comparison analyses and the regression suggest that day shift staff from nursing homes for persons with dementia had the highest opportunities to perform PCC during the pandemic. The same group also rated the importance of leadership as high for performing PCC.

CONCLUSION: Despite the COVID-19 restrictions and all the criticism directed against the care of older people; the day staff felt that they conducted PCC. Staff in nursing homes for dementia had the highest opportunities for PCC and this may be because they are better prepared to provide care for the individual in NH. The importance of leadership was also evident, which means that investment in FLMs is seen as necessary.

Persons with neurological diseases often have some degree of cognitive impairment. They are in need of assistive technology for cognition (ATC) to compensate for cognitive impairments that affect their daily functioning. Goal setting in relation to cognitive deficits using ATC are common in clinical practice, and therapists often set several rehabilitation goals together with a patient. However, these rehabilitation goals are usually phrased differently, which limit the comparison of ATC and rehabilitation goals. It is thus valuable to link the goals to some standardized terminologies, such as the International Classification of Functioning, Disability and Health (ICF). Furthermore, goal achievement is seldom used to evaluate long-term effects of ATC in persons with neurological diseases and limited attention has been paid to the factors that predict goal achievement in using the ATC as cognitive support in persons with neurological diseases. The aim of the project is 3-fold. Firstly, we will use the ICF to link rehabilitation goals regarding the use of ATC in adults with neurological diseases. Secondly, we will evaluate effects of the ATC using goal achievement over a 5-year period. Thirdly, we will explore the variables that predict goal achievement in relation to the effects of ATC.

Background: Children with congenital limb reduction deficiency live with the decisions made by their parents and healthcare professionals about treatments to be carried out during the first years of life. To understand better the meaning of treatment during childhood, it is necessary to listen to adolescents who have had this experience. The aim of this study was to investigate the perceptions of adolescents with congenital limb reduction deficiency concerning the treatment they received during childhood and what it meant to them currently and in the future.

Methods: A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with 10 adolescents (six girls and four boys) with upper and/or lower limb reduction deficiency, median age 17.5 years (range 16–19). The interview data were analysed using a phenomenographic approach.

Results: The treatment received during childhood had contributed to shaping the adolescents, as shown in the emerging description categories Creating opportunities, Choosing one's own path and Belonging in a context. Their current situation fell into three categories: A continuous journey, indicating that they still used the skills learned during childhood; Leaving the door open, indicating that they were not currently using the skills learned during childhood, but felt that there could be opportunities ahead; and Closing a chapter, indicating that they had stopped using their prosthesis or assistive devices and no longer needed those skills. Further, the adolescents' thoughts about the future are portrayed in the categories Uncertainty about the future and Confidence about the future.

Conclusions: An understanding of the meaning of treatment received during childhood may help improve the delivery of treatment and continued support to meet the needs of children with congenital limb reduction deficiency in the short and long term.

OBJECTIVE: To evaluate the effect of multi-grip myoelectric prosthetic hands on performance of daily activities, pain-related disability and prosthesis use, in comparison with single-grip myoelectric prosthetic hands.

DESIGN: Single-case AB design.

PATIENTS: Nine adults with upper-limb loss participated in the study. All had previous experience of single-grip myoelectric prostheses and were prescribed a prosthesis with multi-grip functions.

METHODS: To assess the changes in daily activities, pain-related disability and prosthesis use between single-grip and multi-grip myoelectric prosthetic hands, the Canadian Occupational Performance Measure, Pain Disability Index, and prosthesis wearing time were measured at multiple time-points. Visual assessment of graphs and multi-level linear regression were used to assess changes in the outcome measures.

RESULTS: At 6 months' follow-up self-perceived performance and satisfaction scores had increased, prosthesis wearing time had increased, and pain-related disability had reduced in participants with musculoskeletal pain at baseline. On average, 8 of the 11 available grip types were used. Most useful were the power grip, tripod pinch and lateral pinch.

CONCLUSION: The multi-grip myoelectric prosthetic hand has favourable effects on performance of, and satisfaction with, individually chosen activities, prostheses use and pain-related disability. A durable single-grip myoelectric prosthetic hand may still be needed for heavier physical activities. With structured training, a standard 2-site electrode control system can be used to operate a multi-grip myoelectric prosthetic hand.

This case study describes the use of a capacity measurement tool and a performance measurement tool to evaluate the effect of an assistive device, using upper limb prosthesis as an example of assistive device. The case describes the benefits of using the International Classification of Functioning, Disability and Health to understand “capacity” and “performance” and the importance of using correct measurement tools to measure these two concepts. A patient-reported questionnaire that collects data about daily performance in wide range of activities from real-life environment is a good option for measuring performance when assessment in real-life environment is not possible.

However, behind the measurements, there were several considerations in how I can minimize errors in the measurements. This was done by providing pictures to explain patient-reported questions and by providing training before data collection. It was also beneficial to have an extended recruiting period to achieve a representative sample. This case study provides an insight into the practical details of how a clinical evaluation project was carried out through the eyes of a clinical researcher.

Despite the promising functions of a multi-function hand, it is challenging to learn to use a hand that has up to 36grip patterns. If it requires too much cognitive load to learn to operate a prosthetic hand, the user may eventually stopusing it. Measurement of cognitive load while learning to use a bionic hand will help the therapist to adjust the trainingpace and help the user to achieve success.An innovative, non-obtrusive method for measuring cognitive load is by tracking eye gaze. Gaze measuresprovide pupil diameters that indicate subjective task difficulty and mental effort. Three subjects wore a pair of Tobiieye-tracking glasses during control training and performed eight activities. Eye-tracking data were imported in TobiiPro Lab software for extracting pupil diameter during the activities. Pupil diameter (normal range: 2-4mm duringnormal light) was used to indicate the amount of cognitive load.Pupil diameters were below 4mm in 9 out of 23 training activities. Pupil diameters were above 4mm in all threesubjects when they used precision pinch to perform the activities “stack 4 1-inch wooden blocks” and “pick up smallobjects”. Subject 3 had pupil diameters over 4mm in all training activities. Pupil diameters were largest when thesubjects were adjusting the grip and when they had difficulties in initiating the grip.It seems appropriate to introduce no more than four grips during the first control training session. Further studyis required to determine if pupil diameters will decrease over time when adequate prosthetic training is given.