Gracey et al.

(2017)

UK

RCT

PEDro=6

N_Initial=74, N_Final=59

Population: CVA=23, Infection=3, TBI=33, Tumor=10, Missing=1. Control First (n=34): Mean Age=50.18 yr; Gender: Male=23, Female=11; Mean Time Post Injury=8.62 yr. Assisted Intention Monitoring (AIM, n=36): Mean Age=46.36 yr; Gender: males=23, females=13; Mean Time Post Injury=4.89 yr.

Intervention: Participants were randomized to receive AIM or control first. In the AIM-first group, participants received goal management training followed by text messages for improving achievement of everyday intentions. Control-first group received brain injury information, Tetris game, and non-informational text messages. After 3 wk, participants were crossed over with AIM-first group receiving usual care and control-first group receiving AIM.

Outcome Measures: Mean daily proportion of intentions achieved, Achievement of all goals excluding the phone call task, Profile of Mood States total mood disturbance (POMS MD), Hotel Task, Verbal Fluency.

1.        Participants achieved a greater proportion of intentions during the AIM intervention relative to control (p=0.040).

2.        Participants achieved a greater proportion of goal attainment (without the phone call task) during the AIM intervention relative to control (p=0.033).

3.        No significant Group x Time interaction effect was found for the POMS MD or Hotel Test.

4.        When only comparing group differences at post-intervention phase 1, intention to treat analysis showed no significant difference between groups for proportion of intentions achieved or achievement of goals excluding the phone task.

O’Neill et al.

(2017)

UK

RCT

PEDro=7

N_Initial=27, N_Final=24

Population: TBI=16, Subarachnoid hemorrhage=3, Other=5; Mean Age=45.14 yr; Gender: Male=22, Female=2; Mean Time Post Injury=5.53 yr; Severity: severe.

Intervention: Participants were randomly assigned to the experimental (n=10) or control group (n=14), and assessed before (baseline), during, and after intervention (return to baseline). Experimental group participants received Guide, an audio-verbal interactive micro-prompting software designed to emulate the verbal prompts and questions provided by carers or support workers. Control group participants received rehabilitation as usual.

Outcome Measures: Morning Checklist (number of support worker prompts, number of safety critical and general errors, deviations from and repetitions of the necessary sequence), Satisfaction score (5-point scale).

1.        Compared to baseline, there was a significantly greater reduction in the intervention group than the control group during (p<0.010) and after (p<0.010) the intervention for the number of prompts needed.

2.        There were no significant differences between groups across the three phases in terms of number of errors, sequence errors, or satisfaction scores.

Lannin et al.

(2014)

Australia

RCT

PEDro=8

N=42

Population: TBI; Mean Age=33.5 yr; Gender: Male=26, Female=16; Mean Time Post Injury=9.2 yr.

Intervention: Participants were randomly allocated to either the experimental group (EG; n=21), who received 8 weeks of training in the use of a personal digital assistant (PDA) with an occupational therapist, or the control group (CG; n=21) who received 8 weeks of traditional occupational therapy. Training sessions for the EG focused on PDA training for application and organization into everyday life.

Outcome Measures: Goal Attainment Scale (GAS), Memory Functioning Questionnaire (MFQ) and Memory Compensation Questionnaire (MCQ).

1.        There was a significant difference between EG and CG groups in the functional memory failures subset of the GAS (p=0.0001); however, the total GAS score was not significant between groups (p=0.165).

2.        The caregiver report on the frequency of forgetting and retrospective memory subset of the MFQ were significant between groups (p=0.021, p=0.042 respectively); however, seriousness of forgetting and mnemonic usage subset of the MFQ were not significant between groups (p=0.455, p=0.301 respectively)

3.        Internal strategies subset of the MCQ was significant between groups (p=0.021); however, external strategies subset of the MCQ was not significant between groups (p=0.580).

De Joode et al.

(2013)

Netherlands

RCT

PEDro=5

N=34

Population: TBI=11; Stroke=12; Mixed stroke/TBI=3; Other=8; Gender: Male=24, Female=10. Experimental Group (n=21): Mean Age=42.2yr; Mean Time Post Injury=38.9mo. Control Group (n=13): Mean Age=39.4yr; Mean Time Post Injury=65.9mo.

Intervention: Participants were randomized to either: 1) Control Group: care as usual (paper and pencil aids) aimed at learning skills to support memory, planning and organization, or 2) Experimental Group: participants were trained to use Personal Digital Assistants (PDAs) as a cognitive aid to compensate for dysfunctions. After 8hr of training (T1), 16hr of training (T2), and at 5mo follow-up (T3), assessments were conducted.

Outcome Measures:  Goal Attainment Scaling (GAS), Cognitive Failure Questionnaire, Frenchay Activities Index, General perceived Self-Efficacy Scale, Utrecht Coping List.

1.        GAS improved significantly from baseline to T2 for both groups. The experimental group showed a mean increase of 45.2 (p<0.001) and the control a mean increase of 36.7 points (p<0.001); however, the between-group analysis was not significant (p>0.05).

2.        None of the other outcome measures differed significantly between groups at T1 or T2 (p>0.05).

Powell et al.

(2012)

USA

RCT

PEDro=7

N=29

Population: TBI=23, ABI=6; Mean Age=42.31 yr; Gender: Male=17, Female=12; Mean Time Post Injury=13.59 yr.

Intervention: Patients were assigned to either the systematic instruction group (n=15) or the conventional group (control; n=14). The systematic group was based on direct instruction and mastery, rather than exploratory learning (e.g., errorless learning). The control group received conventional, trial and error learning (e.g., errorful learning). Participant’s sessions targeted selected skills on a personal digital assistant (PDA; Palm Tungsten E2). All participants received 12 sessions (45 min, 2-3 x/wk for 4-6 wk).

Outcome Measures: Assessment of PDA skills, California Verbal Learning Test II-Short Form, Wechsler Memory Scale III (Logical Memory, Visual Reproduction), Controlled word Association Test, Trail Making A and B.

1.        Those receiving systematic instruction performed significantly more (p<0.01) correct tasks at the 30-d follow-up compared to participants receiving the conventional instruction.

2.        Those receiving systematic instruction also performed the correct tasks more quickly (16 sec) than the conventional instruction group (41.15 vs 57.73 sec, p=0.050).

3.        Fluency scores (ability to follow through with a task) were also found to be higher in those in systematic instruction group compared to those in the conventional instruction group at 30 d follow-up (p=0.050).

4.        There was no statistically significant main effect on treatment condition for content generalization.

5.        Overall systematic instruction resulted in better environmental generalization compared to trial and error learning (p<0.050) at post-test, but not 30d follow-up.

Dowds et al.

(2011)

USA

RCT

PEDro=5

N=36

Population: TBI patients: Mean age: 42.1 yr (Age Range: 16-66 yr); Gender: male=17, female=19;

Intervention: Participants were trained on how to use two Personal Digital Assisant devices (Palm OS and Microsoft OS device) to assist them in organizing activities that needed to be completed throughout the week.

Participants were randomly assigned to four memory aid conditions (Palm OS, Microsoft OS, Combined Baseline, or paper organizer) in a crossover fashion.

Outcome Measure: Timely completion rates.

1.        When using the PDAs, the individuals had a higher task completion rate than when they used paper memory aids (Palm OS: p<0.005; Microsoft OS: p<0.001).

2.        Results also indicated that those using the Palm OS PDA had a higher completion rate than those using the Microsoft OS PDA (p<0.0005).

Lemoncello et al.

(2011)

USA

RCT

PEDro=5

N=23

Population: Group A (n=12): Mean age=47.17 yr, mean time post-injury=9 yr; Group B (n=11): Mean age=47.55 yr, Mean time post-injury=12.45 yr.

Intervention: Patients were randomly assigned to group A or group B. In group A participants were assigned to use the Television Assisted Prompting (TAP) system, which gave them personalized task reminders through their television, in the crossover phase participants used their own typical practice (TYP) strategies of remembering what tasks they had to complete. In group B participants started with the TYP phase, and then at crossover used the TAP system.

Outcome Measures: Task completion.

1.        No significant differences were found between groups A or B; therefore, data from the two groups was collapsed.

2.        Task completion was significantly better when participants used the TAP condition (72%) versus the TYP condition (43%).

3.        In the TAP condition participants completed significantly more experimental tasks compared to either preferred (p=0.01) or non-preferred tasks (p=0.01).

Hart et al.

(2002)

USA

RCT

PEDro=5

N=10

Population: TBI: Mean Age: 31.5 yr; Gender: male=8, female=2.

Intervention: Individualised current therapy goals were randomly assigned to a portable voice organizer (n=3) or not having an organizer (n=3), 2-5 days per week.

Outcome Measure: Recall of goals.

Wilson et al.

(2001)

UK

RCT

PEDro=4

N=143

Population: Mean Age: 38.57 yr; Gender: Male=105, female=38; Mean Time Post-Injury: 4.9 yr; Condition: TBI=63 (44.1%), Stroke=36 (25.2%), Other: ABI=44 (30.7%).

Intervention: After a 2-week baseline, patients were randomized into two groups: Group A received a pager first and Group B was put on a waiting list. After 7 weeks of treatment patients switched conditions. Measures were taken during the last 2 weeks of each treatment period/ Patients chose their own tasks in which they wanted to be reminded.

Outcome Measures: Patients’ Ability to Successfully Carry out Everyday Tasks.

Evald

(2018)

Denmark

Pre-Post

N=13

Population: Mean age=41.5yr; Gender: Male=11, Female=2; Injury severity: mean GCS=6.6; Mean time post injury=11 yrs.

Intervention: Each individual received a Windows Phone (version 7.5) for 6-weeks and was asked to use this as their only memory strategy. Five group sessions (1.5 hrs each) were held to help ensure each individual knew how to use the applications on each phone (calendar, reminders, etc.). After the 6-week intervention period a 2-week break was taken to assess all behaviors and then a 6-week follow-up assessment was completed.

Outcome Measures: Prospective Memory Questionnaire (PMQ), Prospective and Retrospective Memory Questionnaire, Cognitive Failures Questionnaire (CFQ), European Brain Injury Questionnaire (BIQ), Hospital Anxiety and Depression Scale (HADS).

1.        Pre- to post-intervention the PMQ (p=0.005) and the Prospective and Retrospective Memory Questionnaire (p=0.014) revealed a significant decrease in the number of self-reported memory problems.

2.        No significant effects were found on common brain injury deficits through the BIQ and CFQ.

3.        No significant effects on mood were reported through the HADS or QoL scale.

4.        When comparing reports from baseline to 6-week follow-up, significant effects on memory and self-reported errors were seen on PMQ (p=0.009), the Prospective and Retrospective Memory Questionnaire (p=0.014), and the CFQ (p=0.000).

Evald et al.

(2015)

Denmark

Pre-Post

N=13

Population: TBI; Mean Age=41.5 yr; Gender: Male=11, Female=2; Mean Time Post Injury=11 yr; Mean GCS=6.6.

Intervention: Participants underwent memory training using smartphones (1 individual and 5 group sessions, 1.5 hr/session, 1 session/wk, for 6 weeks). In the individual session participants were instructed on smartphone setup. During the group sessions participants were instructed on compensatory memory strategies using appointment, tasks and contacts applications. Each group session was completed in 4 steps; 1) introduction to the memory strategy, 2) demonstration of the application, 3) exercises with examples and 4) homework instructions.

Outcome Measure: Self-reported measures of overview, memory, stress and fatigue.

1.        5 of the 13 participants reported memory improvements following smartphone use, while the remaining reported no change.

2.        3 of the 13 participants reported stress improvements following smartphone use while the remaining reported no change.

3.        1 of the 13 participants reported fatigue improvements following smartphone use while the remaining reported no change.

4.        9 of the 13 participants reported a positive overview of smartphone use while the remaining reported no change.

5.        There were no negative events reported.

Waldron et al.

(2012)

Ireland

Pre-Post

N=5

Population: TBI=3, CVA=1, Tumour=1; Mean Age=48.8yr; Gender: Male=4, Female=1; Mean Time Post Injury=23.2yr.

Intervention: Participants were given personal digital assistants (PDAs) and a series of seven prospective memory (PM) tasks that they needed to complete. Baseline measures were taken for three weeks, followed by two weeks of PDA condition. More specifically, the PDA was a palmtop computer (Palm IIIe).

Outcome Measure: Completed tasks.

Gentry et al.

(2008)

Canada

Pre-Post

N=23

Population: TBI patients: Age Range 18-66 yr; Gender: Male=16, Female=7; Time Post-Injury=1-34 yr.

Intervention: Participants were each given a PDA and trained on how to use it by an occupational therapist (OT).

Outcome Measure: Craig Handicap Assessment and Rating Technique Revised (CHART); Canadian Occupational Performance Measure (COPM).

2.        On the COPM, improvements were noted when looking at post training performance and post training satisfaction (p<0.001).

3.        Scores on the CHART-R self-assessment rating scale showed improvement as well post-training (p<0.001).

4.        Significant improvement was seen on the scores of the cognitive independence, mobility, and occupation subsections of the test (p<0.001).

Fish et al.

(2007)

UK

Case Series

N=20

Population: Age Range: 19-60 yr; Gender: Male=15, Female=5; Condition: TBI=14, Other=6.

Intervention: Participants were trained to associate the text message ‘STOP” with a cue for participants to stop and think about what needed to be done, what they were doing etc. Participants were asked to make telephone calls at specific times of the day for a 3-week period.  Over the 3-week period on 5 randomly selected days a text message “STOP” was sent to participants.

Outcome Measure: Completion of task.

1.        During the first week 15% of the participants failed to make the calls.

2.        The effect of cueing on participants had a significant impact on the number of calls made (p<0.001).

3.        Participants made 87.6% of calls when cued but only 71.2% of calls when they were not cued.

4.        Of note there was a positive relationship between the number of calls made (completed) and the time in which they were made (within 5 minutes of the target time).

Burke et al.

(2001)

USA

Pre-Post

N=5

Population: Mean Age: 50 yr; Condition: TBI=3, SAH=2.

Intervention: Assessing patient’s ability to use a patient locator and minder (PLAM) system to assist in their adherence to therapy schedules. Patients were prompted by hospital staff about appointment times when necessary.

Outcome Measure: Number of human prompts necessary to direct a patient to a therapy destination.

1.        Average number of human prompts declined significantly using the PLAM system by more than 50% (p<0.001) and the number of sessions requiring no prompting increased from 7 to 44% (p<0.005).

2.        Patients arrived on average 1.3 minutes earlier using PLAM – a 6.1-minute improvement over baseline.

Wright et al.

(2001a)

UK

Pre-Post

N=12

Population: Mean Age: 39 yr; Gender: male=10, female=2; Mean Time Post-Injury 3yr; Condition: TBI=9, Subarachnoid Hemorrhage=2.

Intervention: Two different computer aid formats for 2 months (with a one-month gap between machines).

Outcome Measure: Attitudes, Usage, Relation to Psychometric Factors.

1.        Appointment diary was used more than any other aid.

2.        High users made more new diary entries (p<0.060) suggesting a conceptual understanding of how to use memory aids in everyday living was a prerequisite for benefiting from them.

Wright et al.

(2001b)

UK

Pre-Post

N=12

Population: Mean Age: 34 yr; Gender: male=6, female=6; Mean Time Post-Injury=6 yr.

Intervention: Two-month comparative study of Casio and HP electronic organizers (one-month break between brands).

Outcome Measure: Frequency of use.

1.        No significant correlations between any single psychometric measure and organizer entries.

2.        People accustomed to using memory aids (any type) made more use of pocket computers (p<0.070).

3.        Low frequency users were put off organizers when it had a physical keyboard (p<0.010).

4.        High frequency users used the keyboard more (p<0.070).

Kim et al.

(2000)

USA

Case Series

N=12

Population: Age Range: 22-67 yr; Gender: male=8, female=4; Condition: TBI=11, CVA=1;

Intervention: Supervised usage trial of a palmtop computer that included scheduling software capable of generating audible reminder cues.

Outcome Measure: Survey of subjects’ use of computer as an aid.

1.        Nine subjects (75%) reported that the palmtop computer had been a useful tool.

2.        Seven of these 9 patients expressed that they continued to use the computer following the completion of the study.

3.        All patients recommended that the computer continue to be used in outpatient brain injury rehabilitation.

van den Broek et al.

(2000)

UK

Case Series

N=5

Population: Age Range: 25-56 yr; Gender: male=4, female=1; Time Post Injury: 19-54 mo; Condition: TBI=1, ABI=4.

Intervention: Evaluate the effectiveness of the external aid “the Voice Organizer” for a period of 3-weeks. Messages could be dictated into the organizer and verbal reminders were repeated at specified times throughout the day.

Outcome Measure: Positive and Negative Affect Schedule (PANAS)

Wilson et al.

(1997)

UK

Pre-Post

N=15

Population: Gender: male=11, female=4; Condition: TBI=10, Stroke=1; ABI=4.

Intervention: Evaluation of a Neuropage, a portable paging system. Patients assessed at baseline and after treatment.

Outcome Measure: Task completion.

1.        There was a significant improvement in task completion between the baseline and treatment phase of each subject (p<0.050).

2.        Mean success at baseline was 37.08%, during treatment (85.56%) and post-treatment (74.46%).