Melissa Brunner

Review of the literature on the use of social media by people with traumatic brain injury (TBI)

Abstract Purpose: To review the literature relating to use of social media by people with a traumatic brain injury (TBI), specifically its use for social engagement, information exchange or rehabilitation. Method: A systematic review with a qualitative meta-synthesis of content themes was conducted. In June 2014, 10 databases were searched for relevant, peer-reviewed research studies in English that related to both TBI and social media. Results: Sixteen studies met the inclusion criteria, with Facebook™ and Twitter™ being the most common social media represented in the included studies. Content analysis identified three major categories of meaning in relation to social media and TBI: (1) risks and benefits; (2) barriers and facilitators; and (3) purposes of use of social media. A greater emphasis was evident regarding potential risks and apparent barriers to social media use, with little focus on facilitators of successful use by people with TBI. Conclusions: Research to date reveals a range of benefits to the use of social media by people with TBI however there is little empirical research investigating its use. Further research focusing on ways to remove the barriers and increase facilitators for the use of social media by people with TBI is needed. Implications for Rehabilitation Communication disabilities following traumatic brain injury (TBI) can be wide-ranging in scope and social isolation with loss of friendships after TBI is common. For many people, social media is rapidly becoming a usual part of everyday communication and its use has the potential to increase communication and social participation for people with TBI. There is emerging evidence and commentary regarding the perceived benefits and risks, barriers and facilitators and purposes of use of social media within the TBI population. Risks associated with using social media, and low accessibility of social media sites, form barriers to its use. Facilitators for social media use in people with TBI include training the person with TBI and their communication partners in ways to enjoy and use social media safely. There is minimal rigorous evaluation of social media use by people with TBI and scant information regarding social media use by people with communication disabilities after TBI. Further investigation is needed into the potential benefits of social media use on communication, social participation and social support with the aim of reducing social isolation in people with TBI.

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

ABSTRACT Purpose: To review the literature on communication technologies in rehabilitation for people with a traumatic brain injury (TBI), and: (a) determine its application to cognitive-communicative rehabilitation, and b) develop a model to guide communication technology use with people after TBI. Method: This integrative literature review of communication technology in TBI rehabilitation and cognitive-communication involved searching nine scientific databases and included 95 studies. Results: Three major types of communication technologies (assistive technology, augmentative and alternative communication technology, and information communication technology) and multiple factors relating to use of technology by or with people after TBI were categorized according to: (i) individual needs, motivations and goals; (ii) individual impairments, activities, participation and environmental factors; and (iii) technologies. While there is substantial research relating to communication technologies and cognitive rehabilitation after TBI, little relates specifically to cognitive-communication rehabilitation. Conclusions: Further investigation is needed into the experiences and views of people with TBI who use communication technologies, to provide the ‘user’ perspective and influence user-centred design. Research is necessary to investigate the training interventions that address factors fundamental for success, and any impact on communication. The proposed model provides an evidence-based framework for incorporating technology into speech pathology clinical practice and research.

Outcomes of speech-language pathology following stroke: Investigation of inpatient rehabilitation and rehabilitation in the home programs

Speech-language pathology outcomes following stroke are poorly understood, and potential predictors of these, such as age and therapy input have not been well documented. For 12 months, the Australian Therapy Outcome Measures (AusTOMs) for Speech Pathology scales were used to rate swallowing and language outcomes for patients (n = 63) receiving rehabilitation post stroke. Outcomes were compared by service type (inpatient versus home based), amount of input and patient age. Greatest improvement was seen on the Swallowing scale. There was no difference in outcomes of inpatients compared to home based rehabilitation patients. There was a trend towards better outcomes with increasing input for the Swallowing scale and for Participation Restriction and Distress/Wellbeing domains. Patients less than 75 years of age had better Participation Restriction and Distress/Wellbeing outcomes, compared to older patients. These results align with previous studies, suggesting that inpatient and home based service models may be equally effective post stroke. Therapy input and patient age were related to some, but not all, domains of the AusTOMs, and these results may have implications for patient management. They should also direct future research to further explore these relationships; for example, to identify optimal input to achieve best outcomes.

Interdisciplinary eHealth for the care of people living with traumatic brain injury: A systematic review

ABSTRACT Objective: To identify literature which discusses the barriers and enablers of eHealth technology and which evaluates its role in facilitating interdisciplinary team work for the care of people with a traumatic brain injury (TBI). Design: Systematic review. Data sources: Studies were identified by searching CINAHL, Embase, Medline, PsycINFO, Scopus, and Web of Science. Study selection: Studies included in the review were required to feature an eHealth intervention which assisted interdisciplinary care for people with TBI. Data extraction: Descriptive data for each study described the eHealth intervention, interdisciplinary team, outcomes, and barriers and facilitators in implementing eHealth interventions. Results: The search resulted in 1389 publications, of which 35 were retrieved and scanned in full. Six studies met all the inclusion criteria for the review. Four different eHealth interventions were identified: (i) an electronic goals systems, (ii) telerehabilitation, (iii) videoconferencing, and (iv) a point-of-care team-based information system. Various barriers and facilitators were identified in the use of eHealth. Conclusion: eHealth interventions have been reported to support interdisciplinary teams for the care of TBI. However, there is a substantial gap in existing literature regarding the barriers and enablers which characterize a successful interdisciplinary eHealth model for people with TBI.

Hashtag #TBI: A content and network data analysis of tweets about Traumatic Brain Injury

ABSTRACT Objective: The aims of this study were to: (a) determine how Twitter is used by people with traumatic brain injury (TBI) and TBI organisations, (b) analyse the Twitter networks and content of tweets tagged with TBI-related hashtags, and (c) identify any challenges people with TBI encounter in using Twitter. Research Design: Mixed methods in a Twitter hashtag study. Methods: Mixed methods in a Twitter hashtag study. Tweets tagged with TBI-related hashtags were harvested from the Twitter website over a one-month period in 2016 and analysed qualitatively and quantitatively. Results: The sample of 29,199 tweets included tweets sent by 893 @users, 219 of whom had a brain injury. Twitter was used to: (a) discuss health issues, (b) raise awareness of TBI, (c) talk about life after TBI, (d) talk about sport and concussion, and (e) communicate inspirational messages. Conclusions: Twitter is an important platform for research and knowledge translation on TBI, and for hearing the voices of people with TBI as they express their personal views and stories of living with TBI and become more visible and influential in Twitter communities. TBI clinicians could use these narratives of people with TBI in Twitter to develop more effective and personally meaningful rehabilitation goals.

Tribes and tribulations: interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI)

BackgroundeHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals’ experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI.MethodsA qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia.ResultsNarrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work.ConclusionsAttention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised.

An eHealth Capabilities Framework for Graduates and Health Professionals: Mixed-Methods Study

Background The demand for an eHealth-ready and adaptable workforce is placing increasing pressure on universities to deliver eHealth education. At present, eHealth education is largely focused on components of eHealth rather than considering a curriculum-wide approach. Objective This study aimed to develop a framework that could be used to guide health curriculum design based on current evidence, and stakeholder perceptions of eHealth capabilities expected of tertiary health graduates. Methods A 3-phase, mixed-methods approach incorporated the results of a literature review, focus groups, and a Delphi process to develop a framework of eHealth capability statements. Results Participants (N=39) with expertise or experience in eHealth education, practice, or policy provided feedback on the proposed framework, and following the fourth iteration of this process, consensus was achieved. The final framework consisted of 4 higher-level capability statements that describe the learning outcomes expected of university graduates across the domains of (1) digital health technologies, systems, and policies; (2) clinical practice; (3) data analysis and knowledge creation; and (4) technology implementation and codesign. Across the capability statements are 40 performance cues that provide examples of how these capabilities might be demonstrated. Conclusions The results of this study inform a cross-faculty eHealth curriculum that aligns with workforce expectations. There is a need for educational curriculum to reinforce existing eHealth capabilities, adapt existing capabilities to make them transferable to novel eHealth contexts, and introduce new learning opportunities for interactions with technologies within education and practice encounters. As such, the capability framework developed may assist in the application of eHealth by emerging and existing health care professionals. Future research needs to explore the potential for integration of findings into workforce development programs.

‘I kind of figured it out’: the views and experiences of people with traumatic brain injury (TBI) in using social media—self‐determination for participation and inclusion online

Abstract Background Social media can support people with communication disability to access information, social participation and support. However, little is known about the experiences of people with traumatic brain injury (TBI) who use social media to determine their needs in relation to social media use. Aims To determine the views and experiences of adults with TBI and cognitive‐communication disability on using social media, specifically: (1) the nature of their social media experience; (2) barriers and facilitators to successful use; and (3) strategies that enabled their use of social media. Methods & Procedures Thirteen adults (seven men, six women) with TBI and cognitive‐communication disability were interviewed about their social media experiences, and a content thematic analysis was conducted. Outcomes & Results Participants used several social media platforms including Facebook, Twitter, Instagram and virtual gaming worlds. All but one participant used social media several times each day and all used social media for social connection. Five major themes emerged from the data: (1) getting started in social media for participation and inclusion; (2) drivers to continued use of social media; (3) manner of using social media; (4) navigating social media; and (5) an evolving sense of social media mastery. In using platforms in a variety of ways, some participants developed an evolving sense of social media mastery. Participants applied caution in using social media, tended to learn through a process of trial and error, and lacked structured supports from family, friends or health professionals. They also reported several challenges that influenced their ability to use social media, but found support from peers in using the social media platforms. This information could be used to inform interventions supporting the use of social media for people with TBI and directions for future research. Conclusions & Implications Social media offers adults with TBI several opportunities to communicate and for some to develop and strengthen social relationships. However, some adults with TBI also reported the need for more information about how to use social media. Their stories suggested a need to develop a sense of purpose in relation to using social media, and ultimately more routine and purposeful use to develop a sense of social media mastery. Further research is needed to examine the social media data and networks of people with TBI, to verify and expand upon the reported findings, and to inform roles that family, friends and health professionals may play in supporting rehabilitation goals for people with TBI.

A single case experimental design study on improving social communication skills after traumatic brain injury using communication partner telehealth training

ABSTRACT Primary objective: To investigate use of telehealth to deliver social communication skills training (TBIconneCT) to people with severe traumatic brain injury (TBI) and their communication partners (CPs). Research design: Feasibility study involving single case experimental design with two participants. Methods and procedures: TBI Express is an established program for improving social interactions between people with TBI and their CPs. To improve access to the program, we developed a modified version called TBIconneCT that can be delivered via videoconferencing. Two participants with TBI and their CPs completed TBIconneCT training. Outcome measures included exchange structure analysis of conversation samples, blinded ratings of conversation samples and self-report measures. Main outcomes and results: The study indicated positive change on blinded ratings of conversation and self-reported measures for both participants. Exchange structure analysis conducted on session-by-session data did not demonstrate treatment effects due to variability during baseline. Conclusion: This study indicated potential for using telehealth to provide social communication skills training to people with TBI and their families. The study findings provide a foundation for a phase one clinical trial which will compare in-person with videoconferencing delivery of TBIconneCT.

Multidisciplinary teams and ICT: a qualitative study exploring the use of technology and its impact on multidisciplinary team meetings

BackgroundMultidisciplinary teams (MDTs) are an integral component in the delivery of health care. This is particularly evident in the delivery of cancer care, where multidisciplinary teams are internationally recognized as the preferred method for service delivery. The use of health information systems and technology are key enabling factors for building the capacity of MDTs to engage in improvement and implementation projects but there is scant research on how MDTs make use of technology and information systems or the kinds of systems needed for them to undertake improvement and implementation research. This paper reports findings on how seven MDTs in cancer care utilized technological and information systems and the barriers and enabling factors that impacted on their uptake.MethodsSeven multidisciplinary teams from two large metropolitan hospitals participated in the study. Qualitative methods including structured observations and semi structured interviews that explored how teams engaged in research and improvement activities were utilized. Participants were also observed and interviewed in relation to their use of data and health information systems. Findings were subject to content analysis and key themes were identified. Interviews were transcribed and de-identified and key themes were subsequently discussed with participants to allow for member checking and further clarification of findings.ResultsA total of 43 MDT meetings across seven tumor streams were observed. Of these, observation notes from 13 meetings contained direct references to emerging technologies and health information systems. Findings from 15 semi-structured interviews were also analyzed in relation to how MDTs used technology in weekly meetings, and the perceived impact of technology. Three broad themes emerged: (1) methods for data collection and use by MDTs, (2) the impact of technology on the MDT meeting environment, and (3) the impact of technology and information systems on clinical decision making.ConclusionThe study demonstrates that real time data collection and imaging may improve patient centered care coordination. However, ICTs can be used sub-optimally by teams. We therefore urge additional research to identify the enabling factors that support better collection and use of outcome data from ICT.