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Efficacy of a Micro-Prompting Technology in Reducing Support Needed by People With Severe Acquired Brain Injury in Activities of Daily Living: A Randomized Control Trial

O'Neill, Brian, DClinPsy; Best, Catherine, PhD; O'Neill, Lauren, BSc; Ramos, Sara D. S., PhD; Gillespie, Alex, PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Malec, James PhD, ABPP

The Journal of Head Trauma Rehabilitation: September/October 2018 - Volume 33 - Issue 5 - p E33–E41
doi: 10.1097/HTR.0000000000000358
Focus on Clinical Research and Practice

Objective: To evaluate the effectiveness of an automated interactive prompting technology in supporting the morning routine of persons with acquired brain injury. The morning routine included maintaining personal hygiene and dressing.

Setting: An inpatient neurorehabilitation hospital.

Participants: Persons with acquired brain injury who required prompting when following their morning routine (n = 24), but were not limited by physical disability or dysphasia, took part in the study. Participants (67% with traumatic brain injury) had impairment on indices of memory and executive function.

Design: A randomized control trial evaluated the effect of an automated interactive micro-prompting device on the number of prompts by trained staff required for successful completion of the morning routine.

Main Measures: Study-specific checklists assessed sequence performance, errors, and verbal prompts required over baseline, rehabilitation as usual, intervention, and return to baseline conditions.

Results: The intervention significantly reduced the support required to complete the task compared with usual rehabilitation.

Conclusions: Micro-prompting technology is an effective assistive technology for cognition, which reduces support needs in people with significant cognitive impairments.

Brain Injury Rehabilitation Trust, Glasgow, United Kingdom (Drs Brian O'Neill and Ramos and Ms Lauren O'Neill); Mental Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom (Dr Brian O'Neill); Health Sciences and Sport, University of Stirling, Scotland, United Kingdom (Dr Best); and London School of Economics, London, United Kingdom (Dr Gillespie).

Corresponding Author: Brian O'Neill, DClinPsy, Brain Injury Rehabilitation Trust, Graham Anderson House, 1161 Springburn Rd, Glasgow, G21 1UU, United Kingdom (

Research supported by a grant from the Chief Scientist Office, Scottish Government (CZH/4/598). The authors thank Michael Oddy, Paula Gribben, and Donna Lindop for consultation on the needs of persons with brain injury; Naomi Bowers for help with data collection; and rehabilitation support workers who allowed their scaffolding of sequences to be recorded and used in the development of Guide activity protocols. The authors are forever indebted to the service users who agreed to participate in the development and clinical trial phases of this study.

The article reports the efficacy of a micro-prompting device (called “Guide”), developed with support from the Chief Scientist Office, and, as an Android and iOS compatible application, with support from the Disabilities Trust, a not-for-profit organization, parent charity of the Brain Injury Rehabilitation Trust and, therefore, employer of SDSR, BON, and LON.

The authors declare no other potential conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.