The range of brain injury symptoms and related behaviors that occur between visits with a care provider represent an opportunity for novel assessment and intervention. Coping with pain, managing emotions, and navigating complex social situations can be missed opportunities to reinforce skills traditionally addressed in clinic based neurorehabilitation. Most providers still rely upon patient self-report or collateral descriptions from caregivers to assess for functional areas to target. Unfortunately, these retrospective reports are often limited by inaccuracies and response bias. With the advance of mobile health (mHealth) technology, there are new opportunities to address this space between clinic visits. Specifically, opportunities exist for in situ assessment and intervention for a range of brain injury effects.
Health behavior research and clinical care has increasingly focused on mHealth technology for behavior change, health promotion and disease prevention.(Castelnuovo et al., 2015; Cole-Lewis & Kershaw, 2010; Fjeldsoe, Marshall, & Miller, 2009; Steinhubl, Muse, & Topol, 2013) This trend is especially pertinent to neurorehabilitation, in which mobile technology has utility in evaluation and treatment outside of the clinic space.(Rodríguez, Vázquez, Casas, & de la Cuerda, 2018) Specifically, mHealth can offer unique opportunities to ecologically assess and embed an intervention within a person’s daily context.(Castelnuovo et al., 2015) This approach is growing in value as mHealth technology becomes more easily adoptable, increasingly cost-efficient, and more robust in its sensing capabilities. A technology that enables mobile neurorehabilitation solutions is the Evalu8NOW system by CreateAbility. Evalu8NOW is a customizable platform for a range of web-based assessments and interventions. These apps are designed to address a range of needs including behavioral health, safety monitoring, and disease management. Assessments are conducted on mobile devices, like a tablet, and enabled by a neutral avatar to enhance receptivity by the client. Further, these apps are both patient and provider facing, in which real-time data can be collected to personalize treatment strategies.
Steve Sutter, CEO and founder of CreateAbility, developed this system to enable clinicians to have greater presence with their clients outside of a traditional clinic visit. Design of this technology was user-centered in which end-users were involved in a range of development aspects, such as informing the design to naming the apps. Mr. Sutter described the inspiration for the technology began when addressing needs of individuals with cognitive decline in rural areas. This project impressed upon him the range of factors salient to disease management that could be assessed remotely to tailor treatment.
To address a range of clinical concerns, a number of standardized assessments can be enabled on the Evalu8NOW system. Assessments with evidence for validity and reliability are available in domains pertaining to pain, anger, mood, cognitive functions, sleep, activity level, and medication adherence. These are intended to measure treatment plan effectiveness as well as provide indicators of an at-risk patient.
Mr. Sutter described a dedication for methods-informed development of the CreateAbility technologies. Accordingly, he partners with neurorehabilitation clinical researchers like Dr. Lance Trexler, Executive Director of the Brain Injury Rehabilitation Research and Program Development at the Rehabilitation Hospital of Indiana.
Internal research is directed by a four-phase process of scientific inquiry from design to technology transfer. The first phase includes preliminary research on technology ideation. Phases two and three include feasibility studies and iterative development. The final stage includes examination of commercialization pathways. Similar to other technology developers, the results of these studies are applied internally.
Considering the context under COVID-19 precautions and the expansion of telehealth services, mHealth options like Evalu8NOW exemplify creative next steps for neurorehabilitative care. Accordingly, there is a call for greater exploration of these tools to address a range of conditions and examine the mechanisms for change associated with the technology. Emerging options, such as just-in-time adaptive intervention approaches, will provide value as these technologies are more readily available for and used by neurorehabilitation clinicians.