Exploring clinicians' experiences of implementing assistive technology for cognition in neurorehabilitation: insights and challenges

Traumatic brain injury (TBI) is a significant public health concern, frequently leading to long-term cognitive, emotional, and functional impairments. Despite growing recognition of the need for intense and long-term neurorehabilitation, access to ongoing support remains inconsistent, particularly within the United Kingdom. Assistive technology for cognition (ATC) has been identified as a potential means of addressing these challenges, offering tools that can support memory, executive functioning, and engagement in activities of daily living. However, while ATC's potential is broadly acknowledged, its integration into clinical practice remains diffuse, and the factors mediating its successful implementation are poorly understood. This thesis examines the role of ATC in neurorehabilitation, with a focus on smartphone-based interventions. A systematic review synthesises existing research on the efficacy of smartphones in supporting memory and executive function for individuals with TBI. Given the heterogeneity of the literature, a narrative synthesis was conducted, evaluating the strengths and limitations of ATC. Evidence for smartphone use in supporting cognition, primarily through the use of electronic calendar functions, was found. Variability in training and inconsistencies in the methodologies of reviewed studies are discussed, further supporting the potential of smartphones as platforms with ATCs. However, more high-quality research is required to inform clinicians and policymakers. Following this, a qualitative study explores how clinicians working in neurorehabilitation, experienced implementing ATC interventions. Semi-structured interviews were conducted with twelve professionals from various neurorehabilitation settings and disciplines. A reflexive thematic analysis was undertaken guided by Braun and Clarke's (2020) six-phase reflexive approach, identifying five overarching themes: 1) Technology is Diffuse, 2) Make it Unique (or don't Bother), 3) Context Matters, 4) Professionals Bring Themselves, and 5) The Person Beyond the Injury. Findings indicate that while ATCs have clear utility, their effectiveness is mediated by training and long-term support, MDT collaboration, and accessibility. It also offers novel insight into an important relational component between the therapist and client that has largely not been addressed in ATC research. The research highlights the need for greater guidance for clinicians, considerations of accessibility, and further evaluation of ATC interventions across clinical settings. Implications for clinical psychology, healthcare services, and future research are discussed. This thesis contributes to research and practice by identifying strategies that clinicians and services can adopt to facilitate the successful implementation of ATC's, while also emphasising the importance of inclusive, person-centred approaches within neurorehabilitation.