Contributed by Kristin Gozdzikowska, Ph.D., CCC-SLP, Laura Fergusson Trust (Canterbury)
From 2014 to 2019, the number of people who own a smartphone worldwide more than doubled, nearing 3 billion individuals. Now, more than ever, people of all ages and backgrounds are connected, controlling an increasingly customised environment for on-demand access to media, music, banking, fitness tracking, calendars, social media, maps – the list goes on and on. Why then, does clinical practice at times feel so far removed from this rapidly advancing technological sector?
It has been said that it takes an average of 17 years for new evidence-based findings to reach clinical practice (Balas & Boren, 2000). However, with dropping prices and increasing access, technology is becoming an integral part of clinical care. Rather than expensive equipment, a biofeedback device can be downloaded on a free app. A wearable sensor patch can monitor blood sugar levels, needle-free. A heart-rate rhythm monitor can help improve awareness of emotional state. Simple alarms and wearable prompts can serve as reminders everyday tasks from medications to grocery lists. What’s more, the use of a smart phone can be increasingly socially acceptable for individuals trying to incorporate and generalise strategies in a community setting without drawing unwanted attention to themselves.
By harnessing available, low-cost technologies, unexpected changes can be made as well. For example, Jo Fox, a physiotherapist at Laura Fergusson Trust, is investigating use of a Fit Bit wearable to increase a client’s number of steps. Not only has the client increased physical activity, but early observations revealed unexpected improvements in response to phone calls and texts due to the tactile vibratory feedback when receiving a message. Now, this client has newfound capacity of self-management – no small feat in the world of traumatic brain injury recovery.
It is important to be mindful, however, that much of technology is designed far from the clinical realm, which may exacerbate the divide between research, technology and clinical practice. This reiterates the importance of including end-users in co-design throughout development, which impacts the robustness of experimental solutions and end-user involvement in emerging technologies. This partly inspired the Laura Fergusson Trust, in collaboration with Marcus King (Callaghan Innovation), Jo Nunnerley (University of Otago/BAIL) and Riley Stockwell & Nadia Thorne (Cerebral Fix), to co-design and test a virtual reality (VR) rehabilitation solution for individuals following TBI. VR has potential advantages as real-world stressors can be simulated and systematically introduced. Focus groups were held with people with lived experience of brain injury and clinicians to introduce the concept of VR and discussing possible applications. These groups fed back that a café setting would be most beneficial. In the newly developed game, users complete functional tasks in an increasingly loud and distracting café environment to increase their awareness of effects of cognitive fatigue after brain injury. Not only was VR well tolerated, after trying the co-designed prototype, one individual with lived experience of TBI stated,
“You put us in the exact right environment, this is exactly what happens when we’re out.”
Future research is currently underway to trial clinical implementation of this VR rehabilitation tool. In the meantime, it is clear this study provides important insights on the value of patient perspectives when developing technology for research and clinical practice. By partnering with individuals with lived experience and interdisciplinary teams, we can further harness the rapidly growing benefits of technology into health.
For more information contact Kristin via: firstname.lastname@example.org