Abstract:
Survivors of traumatic brain injury (TBI) often experience cognitive and physical impairments accompanied by a sense of social isolation. Telemedicine or technologies that deliver therapeutic, and educational resources to consumers and health care professionals from a distance may prove to be valuable resources in providing accessible and affordable health care services. The aims of this study were: 1) to design and build an internet-based, "Virtual Rehabilitation Center" (VRC) that provides rehabilitation, education and support services to brain injury survivors and their families and 2) evaluate the "user-friendliness" of the system in relation to patterns of cognitive impairment. Eight individuals with brain injuries (Age: M=43, SD = 15.4;Years of Education: M = 13.8, SD = 3.15) participated in this study. The mean time since injury was 7.5 years (SD = 6.1). The Neurobehavioral Cognitive Status Exam (NBCSE) provided a brief assessment of intellectual functioning. The VRC contained modules for: 1) reaction time) 2) activities of daily living; 3) telecommunications 4) messaging and 5) help (i.e., FAQ's). While all participants learned how to use the VRC, they differed with respect to the number of "trials to acquisition". That is, those requiring more trials to acquisition showed greater cognitive impairment, than the fewer trials to acquisition group. The specific areas of impairment were: Construction (p =.02), Reasoning-Similarities (p =.01) and a non-significant trend suggesting greater impairment in the areas of calculation and language repetition. The most salient finding to emerge is that all of the participants learned how to use the VRC system even though the rate of learning varied among participants. Moreover, impairments in specific cognitive domains reflecting visual-constructional integration and executive-type functions as well as language processing appeared to be related to how effectively participants learned how to use the VRC system. These findings can be used to develop more effective internet/computer-based telemedicine systems.