Development and Evaluation of an Assistive Prompting System\ud for People with Traumatic Brain Injury

Cognitive deficits in executive functioning are among the most frequent sequelae after traumatic brain injury (TBI) at all levels of severity. Due to these functional deficits in cognition, individuals with TBI often experience difficulties in performing instrumental activities of daily living (IADL), especially those IADLs that involve a sequence of goal-directed actions. We obtained updated information on the use of assistive technology for cognition (ATC) through a survey study among twenty-nine participants with TBI. Results highlighted the needs to support the development and evaluation of ATC in assisting multi-step tasks. Cooking tasks were selected as a representative for they are cognitively demanding and have been identified essential for living independently. With the recent advance in sensing and smart home technologies, it’s possible to provide context-aware prompts with minimal user inputs. However, limited information is known regarding what types of context-aware prompts are really needed by people with TBI in completing cooking tasks. We compared the effectiveness and usability of current available prompting methods (e.g. paper-based prompting method and user-controlled method) among ten individuals with TBI in their home kitchens. We categorized the nature of problems faced by end-users with both prompting methods in cooking tasks and proposed relevant context-aware solutions. A test-bed Cueing Kitchen with sensing and prompting elements was developed to address these identified needs and to evaluate the feasibility of context-aware ATC interventions in assisting people with TBI with kitchen activities. Sixteen individuals with TBI participated in the study. Results showed that comparing to the conventional user-controlled method, the automatic method decreased the amount of external assistance required by participants, received higher ratings in perceived ease-of-use, and was helpful for decreasing user stress levels. However, the user-controlled method showed strengths in offering participants more flexibility and control on the timing of prompts. The contributions from this dissertation not only developed a context-aware prompting testbed and evaluated the feasibility of an automatic system, but also advanced the guidelines and potential solutions for future development of assistive prompting technology for people with cognitive impairments in sequential tasks