Reliability of a computer and Internet survey (Computer User Profile) used by adults with and without traumatic brain injury (TBI).

Brain Injury

ISSN: 0269-9052 (Print) 1362-301X (Online) Journal homepage: http://www.tandfonline.com/loi/ibij20

Reliability of a computer and Internet survey (Computer User Profile) used by adults with and without traumatic brain injury (TBI) Andrea M. Kilov, Leanne Togher & Emma Power To cite this article: Andrea M. Kilov, Leanne Togher & Emma Power (2015) Reliability of a computer and Internet survey (Computer User Profile) used by adults with and without traumatic brain injury (TBI), Brain Injury, 29:11, 1273-1291, DOI: 10.3109/02699052.2015.1042052 To link to this article: http://dx.doi.org/10.3109/02699052.2015.1042052

Published online: 17 Jun 2015.

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Date: 05 November 2015, At: 22:06

http://tandfonline.com/ibij ISSN: 0269-9052 (print), 1362-301X (electronic) Brain Inj, 2015; 29(11): 1273–1291 ! 2015 Taylor & Francis Group, LLC. DOI: 10.3109/02699052.2015.1042052

ORIGINAL ARTICLE

Reliability of a computer and Internet survey (Computer User Profile) used by adults with and without traumatic brain injury (TBI) Andrea M. Kilov, Leanne Togher, & Emma Power

Downloaded by [Australian National University] at 22:06 05 November 2015

Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia

Abstract

Keywords

Purpose: To determine test–re-test reliability of the ‘Computer User Profile’ (CUP) in people with and without TBI. Method: The CUP was administered on two occasions to people with and without TBI. The CUP investigated the nature and frequency of participants’ computer and Internet use. Intra-class correlation coefficients and kappa coefficients were conducted to measure reliability of individual CUP items. Descriptive statistics were used to summarize content of responses. Results: Sixteen adults with TBI and 40 adults without TBI were included in the study. All participants were reliable in reporting demographic information, frequency of social communication and leisure activities and computer/Internet habits and usage. Adults with TBI were reliable in 77% of their responses to survey items. Adults without TBI were reliable in 88% of their responses to survey items. Conclusions: The CUP was practical and valuable in capturing information about social, leisure, communication and computer/Internet habits of people with and without TBI. Adults without TBI scored more items with satisfactory reliability overall in their surveys. Future studies may include larger samples and could also include an exploration of how people with/without TBI use other digital communication technologies. This may provide further information on determining technology readiness for people with TBI in therapy programmes.

Computer, internet, reliability, survey, traumatic brain injury

Introduction Computers and the Internet are broadening the interests and skills of people who use technologies for entertainment, organization, accessing information and communicating with other people [1–3]. These activities and technologies may be helpful for populations with a disability, who are looking for information or for opportunities to meet new people or maintain relationships that would otherwise be restricted by their disabilities [3–5]. Todis et al. [4] identified a shortage in the literature concerning email and computer use of people with disabilities. The authors were concerned about the lack of knowledge about the needs, barriers and supports required by people with acquired cognitive impairments (ACI) to use emails and the computer for socialization and other purposes. Todis et al. [4] surveyed 133 people including people with ACI, professionals and carers to ascertain if age, education and computer ownership influenced computer use of people with ACI. The survey used by Todis, et al. [4] was entitled the ‘Computer User Profile’ and it examined the nature and frequency of social communication and computer and Internet activities. Correspondence: Andrea M. Kilov, Discipline of Speech Pathology, University of Sydney, Cumberland Campus 75 East St, Lidcombe, New South Wales 2141, Australia. Tel: 612-9351-9639. Fax: 612-9351-9173. E-mail: [email protected]

History Received 20 October 2014 Revised 22 March 2015 Accepted 12 April 2015 Published online 17 June 2015

The ‘Computer User Profile’ (CUP) contains 62 items across four domains (Appendix 1): (1) demographics (5 items), (2) social communication and activity engagement (30 items), (3) injury-related information (8 items) and (4) computer use (19 items). Responses to items on the survey range from being ticks in boxes along 7-point likert scales, to ticks in boxes on nominal yes/no questions or categorical-type questions. Thirty-one out of the total 62 items required responses to be marked on a 7-point likert scale (Section II, Questions 1a–n, 2b, 3b; Section III, Questions 11a–i). The items which contained likert scales referred to how often participants engaged in social communication and leisure activities (for example, seeing friends, talking on the phone, watching TV, playing sport, reading) and how often they participated in computer/Internet activities (e.g. emailing, using chatrooms, downloading music). The points on the likert scale were labelled with written descriptors to enable participants to identify the frequency of their participation in each activity. The written labels (and their respective numerical values) on the 7-point likert scale included: (1) ‘several times a day’, (2) ‘about once a day’, (3) ‘3–5 days a week’, (4) ‘1–2 days a week’, (5) ‘every few weeks’, (6) ‘less often’ and (7) ‘never’. The remaining items in the ‘Computer User Profile’ (31 out of 62) were categorical and required yes/no check boxes to be ticked or a single word response or short phrase to be selected from multiple choice responses (Section I, Questions 1–5;


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Section II, Questions 2a, 3a, 4; Section III, Questions 1–8; Section IV, Questions 1–10). It was not possible to derive a cumulative tally of responses to items in the CUP. Todis et al. [4] conducted focus groups after the survey to obtain more detailed information about the barriers encountered whilst emailing and also to compare relative advantages and disadvantages of using email, telephonic and mail communication systems for people with ACI. Todis et al. [4] found that age and education levels did not influence computer use, but injury severity did impact on computer use (people with more severe injuries did not use computers as often as people with less severe injuries). Most people with ACI (80%) in the study by Todis et al. [4] owned their own computer and most of them reported difficulties keeping in touch with relatives and friends who lived far away from them. The survey and focus groups revealed a number of barriers for people with ACI whilst using emails, computers and the Internet. Some of these difficulties included trouble operating the keyboard and mouse, challenges with communication skills, cognitive and processing difficulties, visual deficits, fatigue and fear of having difficulties when using email systems and other technology systems. Todis et al. [4] suggested that emails and other technological utilities need to be more accessible for people with ACI. This highlighted that ownership of technology is not sufficient to promote successful use of its applications, especially for people with ACI [4]. Rather, a through surveillance of a person’s needs and readiness for using technology (with consideration given to cognitive, physical, visual, communicative and social limitations) should occur first so that appropriate training, support and adaptations to devices and interfaces can be provided for the technology user. The CUP [4] appears to be an appropriate and practical clinical tool to achieve surveillance of technology needs of people with ACI in light of injury related variables and other social and leisure-based activities. However, there have been no reliability measures established for use of the CUP survey in clinical or normative populations to date. Therefore, this paper aims to: (1) describe how the CUP was adapted for use with nonclinical participants and (2) establish test–re-test reliability measures of items on the original and adapted versions of the CUP when used by people with and without traumatic brain injuries in an attempt to establish further psychometric properties of this survey. People with traumatic brain injury (TBI) were chosen as the clinical population due to the variety of cognitive, physical, emotional and other injury related changes that impact on their ability to participate in activities of daily living, including activities centred around technology and communication [3, 4, 6–8].

Method The Computer User Profile (CUP) and its modification to the Adapted CUP Todis et al. [4] used the Computer User Profile (CUP) to examine the nature and frequency of social communication and computer and Internet use of people with ACI [4]. Considering that people with moderate-to-severe TBI are

Brain Inj, 2015; 29(11): 1273–1291

likely to have acquired cognitive impairments [8, 9], the use of the CUP was deemed to be a valuable and appropriate tool for surveying computer and Internet use of participants with TBI recruited into this study. The CUP was described in detail in the introduction. In summary, it contains 62 items across four domains relating to personal information, injury-related facts and computer and Internet activity. Responses to items on the CUP did not require long sentences or paragraphs. Responses were mostly in the form of a rating on a 7-point likert scale relating to frequency of activity or ticks in boxes next to yes/no or categorical questions. In this study, the CUP [4] was adapted for use with a control group, consisting of adults who did not have a TBI or cognitive impairments. This survey was called the ‘Adapted Computer User Profile’. The Adapted CUP excluded items relating to injury-related information (Appendix 2), which meant that Section II (which contained eight injury-related items) was removed from the original CUP survey. Consequently, only three out of the original four sections of the original CUP and 54 out of the original 62 items of the original CUP remained in the Adapted CUP. In the Adapted CUP, Section I contained five items on the demographics of participants (as in the original CUP), Section II contained 30 items on social communication activities (as in the original CUP) and Section III contained 19 items relating to computer and Internet use (as in the original CUP). In the Adapted CUP, 31 items required responses to be marked on a 7-point likert scale and the remaining items (23) contained check boxes next to yes/no and categorical questions. The wording, sequence, and presentation of the 54 items in the Adapted CUP were identical to how they appeared in the original CUP. Eligibility criteria and sample size calculations Eligibility criteria for participation Adults with and without TBI were recruited for this study. For the TBI group, inclusion criteria required the participants to: (1) be 18–65 years of age, (2) have a diagnosis of moderate–severe TBI, as per medical and allied health reports, (3) have English as a primary language and (4) have an interest in using the computer/Internet. Participants were excluded from the TBI group if they had a history of psychiatric illness. For the control groups (adults and teenagers), the inclusion criteria required the participants to: (1) be 18–65 years of age, (2) have English as a primary language and (3) have an interest in using the computer/Internet. Participants were excluded from the control group if they had a known history of TBI, any language or cognitive impairment and/or had a history of psychiatric illness. All participants were required to read information statements and sign consent forms prior to participating in the study, as well as obtain the signature of a guardian, carer or witness on their consent forms. Reliability and sample size calculations The intra-class correlation coefficient (ICC) is a common measure of test–re-test reliability for surveys and it can be

Reliability of CUP with TBI

DOI: 10.3109/02699052.2015.1042052


used when many raters judge the same items at different points in time [10]. Thus, the ICC is useful for measuring whether items in surveys are consistent over time when people use a survey on more than one occasion [11]. If the correlation (ICC) between responses during the first and second times of completing the survey is high, then there is a high test–re-test reliability [12]. High reliability is considered to be a desirable property of a survey. Although intra-class correlation coefficients of 0.80 or more are considered to be high [12], reliability coefficients of 0.60 are classified as substantial [13]. Therefore, in this study, any reliability coefficient above 0.60 was classified as having satisfactory intra-rater reliability. According to sample size calculations, a sample size of 15 participants in each group was required to establish a reliability coefficient of 0.60 with power at 80% and a set at 0.05 [14]. Procedure This study was approved by the ethics committee at the University of Sydney, Australia (Reference 02-2009/11393). An email was circulated on two occasions to networks of staff and students at the University of Sydney and to relevant TBI networks (including private practices in Sydney, readers of a newsletter published by the Brain Injury Association of NSW and to people with TBI who had previously been involved in other research and had indicated a willingness to be contacted for future TBI studies performed at the University of Sydney). Interested participants were invited to email or phone the researchers to express interest in participating in the study. At this point, information statements and consent forms were provided in writing and participants were invited to ask further questions or seek clarification in writing or on the telephone. Participants who met eligibility criteria and returned signed consent forms (which included a second signature from a witness or legal guardian) were recruited for this study. On receipt of consent forms, participants were issued with a hard copy of either the ‘Computer User Profile’ (for participants with TBI) (Appendix 1) or the ‘Adapted Computer User Profile’ (participants without TBI) (Appendix 2). The surveys were marked with a label ‘T1’ (Time 1), indicating that this was the first time that they were completing the survey. A date was also recorded to assist the researcher monitor when the second administration of the survey would need to occur. All participants were asked to complete the T1 survey and return it to the researchers via email, via fax or via mail with a postage paid envelope. They were also required to indicate if they preferred to receive the second (‘T2’) survey by email, fax or post when they returned their T1 survey. If participants did not return the T1 survey by a week after receiving it, the researcher sent a reminder text message (SMS) via mobile phone and an email to remind them about completing and returning the survey. Participants who were only contactable by telephone received a telephone call to remind them about completing and returning the T1 survey. Participants were provided with up to two extra reminders about returning the survey and, if there was no response following the second reminder, they were excluded from final tallies in the study. Two weeks after the initial completion of the ‘Computer User Profile’ or the ‘Adapted Computer User Profile’,

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participants were issued with another copy of the survey which had a ‘T2’ label. This indicated Time 2 of survey administration. Participants were asked again to complete the survey and return it to the researcher via email, via fax or via mail with a postage paid envelope on completion. If participants did not return the T2 survey by a week after receiving it, the researcher sent a reminder text message (SMS) via mobile phone and an email to remind them about completing and returning the survey. Participants who were only contactable by telephone received a telephone call to remind them about completing and returning the T2 survey. Participants were provided with up to two extra reminders about returning the survey and, if there was no response following the second reminder, they were excluded from final tallies in the study. The period of 2 weeks between survey administrations was chosen in this study because it has been deemed to be an acceptable time interval for measuring test– re-test reliability of health-related and quality-of-life instruments and also in interviews [15, 16]. Data analysis Data collected from the surveys at T1 and T2 was entered into Microsoft Excel for Windows XP for data collation and then it was entered into SPSS for Windows (Version 14.0) [17] for statistical analyses. Data was screened for normality and then descriptive statistics were used to summarize responses to survey items at T1 and T2. Using data summaries (described above), test–re-test reliability measures were determined using SPSS [17] for: (1) Items which required responses to be marked on a scale (7-point likert scale) (Section II, Questions 1a–n, 2b, 3b; Section III, Questions 11a–i). (2) Items which required responses to be marked in categories or in a dichotomous yes/no form (Section I, Questions 1–5; Section II, Questions 2a, 3a, 4; Section III, Questions 1–10). For items with responses on a scale, the intra-class correlation coefficient (ICC) was calculated to determine how consistent participants’ responses were at T1 and T2 [10, 18]. The ICC for T1 and T2 responses was calculated with a 95% confidence interval, using a 2-way random model and selecting an absolute agreement model. These conditions have been identified as being good for measuring reliability [18]. For items with responses in a dichotomy or category, the Kappa coefficient (K) was calculated to determine how consistent participants’ responses were at T1 and T2. The following criteria were used to describe the ICC and K coefficients: 0.40 (weak), 0.41–0.60 (moderate), 0.61–0.80 (substantial) and 0.81–1.00 (high–excellent) [12, 14, 16, 19]. Any ICC or K coefficient in the substantial or high–excellent ranges was considered to indicate ‘satisfactory’ reliability. An ICC or K of 1.00 represented perfect agreement between T1 and T2 scores.

Results Description of the TBI group There were 27 surveys sent out to adult participants with TBI who provided consent to participate in the study. Six out of 27

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Table I. Summary table of participants with and without TBI included in this study. Adults with TBI

Adults without TBI

Number of surveys sent out at Time 1 Number of surveys included in study Male: Female count Age range (years) of participants (average age in years) Education status of participants

27 16 10:6 (60% male) 22–57 (36.1)

60 40 22:18 (55% male) 18–60 (33.0)

University course (31.3%) TAFE course (25.0%) High school attendance (43.9%)

Causes of injury

University degree (67.5%) TAFE course (15.0%) HSC exams (Year 12) (7.5%) Up to high school (10.0%) N/A


Range of sensory, motor and emotional impairments

Range of cognitive impairments

Motor vehicle accidents Pedestrian/pushbike accidents Abuse/insult injuries Sports or related injuries Vision loss (41.2%) Hearing loss (17.7%) Temperature and other sensory loss (23.5%) Difficulty ambulating (41.2%) Reduced hand/finger use (29.4%) Reduced movement/co-ordination (58.8%) Loneliness (62.5%) Anger (50.0%) Sadness and reduced esteem (43.8%) Anxiety (37.5%) Fear (6.3%) Poor memory (81.3%) Poor problem-solving (68.8%) Planning/organization difficulties (56.3%) Language difficulties (50.0%) Impulsivity (50.0%) Poor self-awareness (43.8%) Poor attention (43.8%) Visuoperceptual processing and error detection difficulties (37.5%) Reduced initiation (31.3%).

N/A

N/A

TBI, traumatic brain injury; TAFE, Technical and Further Education; N/A, Not applicable.

surveys were returned to the researchers without prompting and a further 12 surveys were returned with a reminder via SMS, email or via the telephone. These 18 surveys were marked as ‘T1’ (Time 1). Ten out of 18 participants chose to receive their ‘T2’ (Time 2) survey via email and eight out of 18 participants chose to receive their T2 survey via post. After all T2 surveys were sent out, only eight out of 18 were returned without reminders. Four out of 18 T2 surveys were sent back after one reminder (SMS and email) and a further four were returned when two reminders were issued 1 week apart from each other. A final count of 16 T1 and T2 surveys were included in the final reliability analysis for the group of adults with TBI, which meant that only two out of 18 responders (11%) did not fulfil requirements of the study and either dropped out or withdrew due to other commitments at the time of this study. Demographic data for adults with TBI was collected from their responses to Question 1 of Section I in the ‘Computer User Profile’, which asked about participants’ age, education and living conditions (Table I). Of the 16 adults with TBI that were included in this study, six were females (37.5%) and 10 were males (62.5%). The mean age of participants was 36.1 years (SD ¼ 11.3), but the range of ages varied between 22.0–57.0 years of age. The majority of participants had attended high school, with smaller proportions having completed a Technical and Further Education (TAFE)

(college or trade) course (25.0%) or a University course (31.3%). There were a range of causes of TBI including motor vehicle accidents, pedestrian/pushbike accidents, abuse/insult injuries and sports or other related injuries. Participants reported lengths of hospitalization varying from a minimum of 1 week to a maximum of 6 months and lengths of PTA varied from less than 1 week to over 1 month. All participants had sustained a moderate-to-severe TBI. There were no participants with mild TBI. All 16 participants with TBI reported that they experienced some kind of sensory and motor impairments, including vision loss (41.2%), hearing loss (17.7%), temperature and other sensory loss (23.5%), difficulty ambulating (41.2%), reduced hand/finger use (29.4%), reduced movement/ co-ordination (58.8%), right hemiplegia (41.2%), left hemiplegia (17.7%) and other motor impairments (11.8%). They also all reported experiencing a variety of emotional issues, with 62.5% reporting loneliness, 50.0% reporting anger, 43.8% reporting sadness and reduced self-esteem, 37.5% reporting restlessness and anxiety and 6.3% reporting fear. Furthermore, all 16 participants reported that they experienced a range of cognitive difficulties including poor memory (81.3%), problem-solving (68.8%), planning/organization (56.3%), language (50.0%), impulsivity (50.0%), self-awareness (43.8%), attention (43.8%), visuoperceptual processing and error detection (37.5%) and initiation (31.3%).


DOI: 10.3109/02699052.2015.1042052


Description of the control group There were 60 surveys sent out to adult control participants who provided consent to participate in the study. Fifty out of 60 surveys were returned to the researchers and they were marked T1. Thirty-five out of 50 participants chose to receive their T2 surveys via email and 15 out of 50 responders chose to receive their T2 surveys via post. After all T2 surveys were sent out, only 10 out of 50 were returned without reminders. Two out of 50 T2 surveys were sent back after one reminder (SMS and email) and a further 28 were returned when two reminders were issued, 1 week apart from each other. A final count of 40 T1 and T2 surveys was included in the final reliability analysis of adult data, which meant that one third (33.3%) of original responders (20 participants) did not fulfil requirements of the study and either dropped out or withdrew due to other commitments at the time of this study. Demographic data for the adult participants without TBI was collected from their responses to Question 1 of Section I in the ‘Adapted Computer User Profile’, which asked about participants’ age, education and living conditions (Table I). Of the 40 adults that were included in this study, 18 were females (45.0%) and 22 were males (55.0%). The mean age of participants was 33.0 years, but the range of ages varied between 18.0–60.0 years of age (SD ¼ 14.0). The majority of participants had completed a University degree as their highest level of education (67.5%), with smaller proportions having completed a TAFE (college or trade) course (15.0%), their HSC exams (Year 12) (7.5%) or their school certificate (Year 10) and/or Year 11 (10.0%). None of the control participants reported cognitive, motor or communication impairments. Normality of distributions of data sets Parametric statistical analysis was used to compare T1 and T2 data for items in normal distributions using paired t-tests. Non-parametric statistical analysis was used to compare T1 and T2 data for items not in normal distributions using Signed Wilcoxon Rank tests. ICC and Kappa coefficients per item of the original and adapted versions of the Computer User Profile (CUP) have been summarized in tables below

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embedded in the results sections, along with upper and lower bound values at a 95% confidence interval (CI) for ICCs. Section I There were no discrepancies in participants’ Time 1 (T1) or Time 2 (T2) responses to Questions 1–6 of Section I of the ‘Computer User Profile’. This resulted in perfect intra-rater reliability concerning demographic items of the survey for adults with TBI and adults without TBI. Additionally, participants with TBI were reliable in responding to injuryrelated items in Questions 1–8 of Section III of their surveys (this section was removed from surveys provided to control participants). Although no scales or dichotomies were used in Questions 1–8 of Section III for participants with TBI, the consistency of content provided by participants indicated that the items had satisfactory reliability. Section II Question 1 Question 1 of Section II asked participants to rate how frequently they participated in a range of leisure, communication and computer/Internet activities. Responses were in the form of a 7-point likert scale, which identified how frequently participants engaged in each activity. Adults with and without TBI had 11 out of 12 items with satisfactory reliability (Table II). Questions 2–3 Question 2 of Section II asked participants to identify a person living within an hour from them and then rate how frequently they communicated with them using a variety of verbal and written communication options. Question 3 of Section II asked participants to identify a person living more than an hour away from them and then rate how frequently they communicated with them using a variety of verbal and writtenfour 4 categories (girl/boyfriend, friend, relative or carer/therapist) and a rating of how frequently participants communicated with the person they nominated using the five communication modalities aforementioned on a 7-point likert scale. Adults with TBI had seven out of 12 items with

Table II. Summary of reliability coefficients for each of the 12 items in Question 1, Section II. Item

Adults with TBI

Adults without TBI (control)

1a. Spend time with friends 1b. Talk on the phone 1c. Play sport 1d. Play cards/board games 1e. Do volunteer work 1f. Take a class 1g. Go to therapy 1h. Spend time reading 1i. Watch TV 1j. Play a video or computer game 1k. Use the computer/ Internet 1l. Go on Internet chatrooms Total number of items with substantial-to-high reliability

ICC ¼ 0.92, 95% CI ¼ 0.78–0.92 ICC ¼ 0.85, 95% CI ¼ 0.58–0.95 ICC ¼ 0.99, 95% CI ¼ 0.96–1.00 ICC ¼ 0.65, 95% CI ¼ 0.01–0.88 ICC ¼ 0.54#, 95% CI ¼ 0.32–0.84 ICC ¼ 0.69, 95% CI ¼ 0.10–0.89 ICC ¼ 0.67, 95% CI ¼ 0.07–0.88 ICC ¼ 0.90, 95% CI ¼ 0.72–0.96 ICC ¼ 0.74, 95% CI ¼ 0.25–0.90 ICC ¼ 0.82, 95% CI ¼ 0.48–0.93 ICC ¼ 0.87, 95% CI ¼ 0.63–0.95 ICC ¼ 0.82, 95% CI ¼ 0.46–0.94 11/12

ICC ¼ 0.88, 95% CI ¼ 0.78–0.94 ICC ¼ 0.84, 95% CI ¼ 0.70–0.92 ICC ¼ 0.81, 95% CI ¼ 0.64–0.90 ICC ¼ 0.59#, 95% CI ¼ 0.22–0.78 ICC ¼ 0.92, 95% CI ¼ 0.84–0.96 ICC ¼ 0.86, 95% CI ¼ 0.74–0.93 ICC ¼ 0.70, 95% CI ¼ 0.43–0.84 ICC ¼ 0.66, 95% CI ¼ 0.35–0.82 ICC ¼ 0.91, 95% CI ¼ 0.83–0.95 ICC ¼ 0.84, 95% CI ¼ 0.69–0.91 ICC ¼ 0.70, 95% CI ¼ 0.42–0.84 ICC ¼ 0.91, 95% CI ¼ 0.83–0.95 11/12

#, weak-to-moderate reliability; ICC, Intra-class Correlation Coefficient; CI, confidence interval.

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Table III. Summary of reliability coefficients for items in Question 2 and Question 3, Section II. Item

Adults with TBI


2a. Person living within an hour away 2b. Talk in person 2c. Talk on the telephone 2d. Use emails 2e. Use written notes 2f. Meet in chatrooms 3a. Person living 41 hour away 3b. Talk in person 3c. Talk on the telephone 3d. Use emails 3e. Use written notes 3f. Meet in chatrooms Total number of items with substantial-to-high reliability

ICC ¼ 0.95, 95% CI ¼ 0.90–0.96 ICC ¼ 0.90, 95% CI ¼ 0.75–0.96 ICC ¼ 0.96, 95% CI ¼ 0.90–0.95 ICC ¼ 0.82, 95% CI ¼ 0.51–0.93 ICC ¼ 0.52#, 95% CI ¼ 0.30–0.82 ICC ¼ 0.96, 95% CI ¼ 0.90–0.99 ICC ¼ 0.88, 95% CI ¼ 0.65– 0.96 ICC ¼ 0.13#, 95% CI ¼ 0.60–0.41 ICC ¼ 0.26#, 95% CI ¼ 1.47–0.76 ICC ¼ 0.72, 95% CI ¼ 0.17– 0.90 ICC ¼ 0.30#, 95% CI ¼ 3.53–0.58 ICC ¼ 0.18#, 95% CI ¼ 3.20–0.62 7/12

ICC ¼ 0.94, 95% CI ¼ 0.89–0.97 ICC ¼ 0.49#, 95% CI ¼ 0.03–0.79 ICC ¼ 0.73, 95% CI ¼ 0.49–0.86 ICC ¼ 0.91, 95% CI ¼ 0.82–0.95 ICC ¼ 0.24#, 95% CI ¼ 0.47–0.60 ICC ¼ 0.97, 95% CI ¼ 0.95–0.99 ICC ¼ 0.94, 95% CI ¼ 0.85–0.98 ICC ¼ 0.77, 95% CI ¼ 0.56–0.88 ICC ¼ 0.88, 95% CI ¼ 0.78–0.94 ICC ¼ 0.79, 95% CI ¼ 0.60–0.89 ICC ¼ 0.77, 95% CI ¼ 0.56–0.88 ICC ¼ 0.87, 95% CI ¼ 0.76–0.93 10/12



Table IV. Summary of reliability coefficients for items in Question 4, Section II. Item 4a. Contact Family 4b. Contact Friends 4c. Meet new people 4d. Business enquiries 4e. Contact professionals 4f. Planning an event Total number of items with substantial to high reliability

Adults with TBI


K ¼ 0.43# K ¼ 0.02# K ¼ 0.47# K ¼ 0.23# K ¼ 0.38# K ¼ 0.24# 0/6

K ¼ 0.54# K ¼ 0.73 K ¼ 0.41# K ¼ 0.42# K ¼ 1.00 K ¼ 0.43# 2/6

#, weak-to-moderate reliability; K, Kappa coefficient.

satisfactory reliability and adults without TBI had 10 out of 12 items with satisfactory reliability (Table III). Question 4 Question 4 of Section II asked participants to indicate the purposes (choice of six options) for their use of email and chatrooms. These purposes included: contacting family, contacting friends, meeting new people, making business enquiries, contacting professionals and planning an event. Where there were ticks in boxes for each purpose, responses were considered to be ‘yes’ and where there were no ticks, responses were considered to be ‘no’. Subsequently, responses were coded as dichotomous and in nominal categories of ‘yes’ or ‘no’. Reliability coefficients for these items have been summarized in Table IV. Adults with TBI were unreliable across all six items in this question. Adults without TBI were reliable in only two out of six items in this question. Section III for control participants and Section IV for participants with TBI

most suitable answer out of a choice of three possible answers which related to keyboard typing habits (based on speed and familiarity with the keyboard). Adults with TBI tended to report a need to look at the keyboard keys whilst typing, while adults without TBI reported that they were able to type without looking much at the keyboard. All adults without TBI owned a computer, but not all adults with TBI owned a computer (10 out of 16 participants). All participants reported that they could read and write a short note on the computer. Questions 9 and 10 were yes/no type questions and were coded as nominal data in a dichotomy. Question 9 asked participants to indicate why they were not using a computer. In this question, a series of 10 possible reasons were provided to participants to explain why they were not using a computer. These reasons included financial problems, motor problems, visual problems, hand–eye problems, access issues, complexity, it takes too long, feelings of intimidation, disinterest and other. The majority of participants in both groups denied that any of these reasons impacted on computer use. However, a few adults with TBI reported that they found it complex or not interesting to use a computer. Question 10 asked participants to indicate why they did not use chatrooms. In this question, seven possible reasons were provided to participants to explain why they were not using chatrooms. The reasons for not using chatrooms included not having a computer, not being allowed one at home/school, feeling intimidated, complexity, time it takes, not being interested and other. The majority of all participants denied that any of these reasons impacted on their chatroom use, with the exception of a minority of adults with TBI who reported that they found it complex, lengthy and/or not interesting. For the items comprising Questions 1–10 of Section III, adults with TBI were reliable in 23 out of 25 items and adults without TBI were reliable in all 24 items (Table V).

Questions 1–10

Question 11

The first eight questions of Section III/IV asked participants about their computer use and typing habits. Question 2 was only applicable to adults with TBI as it asked about pre-injury computer use. Seven out of eight questions were yes/no type questions and were coded as nominal data in a dichotomy. One question (Question 7) allowed participants to choose the

Question 11 of Section III/ IV asked participants to rate how frequently they used the computer and Internet over the past 6 months with regard to nine activities. These activities included word processing, organization (schedules, reminders), work, games, finding information, buying a product or service, downloading (music, images, etc.), email


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Table V. Summary of reliability coefficients for items in Questions 1–10 in Section III for controls and in Section IV for adults with TBI. Item 1. 2. 3. 4. 5. 6. 7. 8.

Do you currently own a computer? Did you use a computer before your injury? Are you able to read a short, type-written note? Do you go on Internet chatrooms? Are you able to participate in Internet chatrooms? Is there someone available to help you use a computer? Do you currently own a computer? Keyboard typing habits

9. Reasons for not using a computer (10 items) 10. Reasons for not using chatrooms (7 items) Total number of items with substantial to high reliability

Adults with TBI


K ¼ 1.00 K ¼ 1.00 K ¼ 1.00 K ¼ 1.00 K ¼ 1.00 K ¼ 0.71 K ¼ 0.59# ICC ¼ 0.49#, 95% CI ¼ 0.69–0.84 K ¼ 0.97 (7/10 items with perfect agreement) K ¼ 0.94 (2/7 items with perfect agreement, 5/7 items with excellent agreement) 23/25

K ¼ 1.00 N/A K ¼ 1.00 K ¼ 1.00 K ¼ 0.60 K ¼ 1.00 K ¼ 0.69 ICC ¼ 0.90, 95% CI ¼ 0.81–0.95 K ¼ 1.00 (all items with perfect agreement) K ¼ 1.00 (all items with perfect agreement) 24/24


#, weak-to-moderate reliability; ICC, Intra-class Correlation Coefficient; CI, confidence interval; K, Kappa coefficient; N/A, not available.

Table VI. Summary of reliability coefficients for items in Question 11 in Section III for adults with and without TBI in Section IV. Item

Adults with TBI


11a. Word processing 11b. Organization 11c. Work 11d. Games 11e. Finding information 11f. Buying products or services 11g. Downloading (e.g. music) 11h. Emailing 11i. Internet chatrooms Total number of items with substantial-to-high reliability

ICC ¼ 0.91, 95% CI ¼ 0.74–0.97 ICC ¼ 0.98, 95% CI ¼ 0.94–0.99 ICC ¼ 0.40#, 95% CI ¼ 0.74–0.79 ICC ¼ 0.76, 95% CI ¼ 0.30–0.92 ICC ¼ 0.80, 95% CI ¼ 0.40–0.93 ICC ¼ 0.95, 95% CI ¼ 0.86–0.98 ICC ¼ 0.63, 95% CI ¼ 0.05–0.87 ICC ¼ 0.51#, 95% CI ¼ 0.27–0.82 ICC ¼ 0.77, 95% CI ¼ 0.35–0.92 7/9

ICC ¼ 0.87, 95% CI ¼ 0.75–0.93 ICC ¼ 0.82, 95% CI ¼ 0.62–0.91 ICC ¼ 0.81, 95% CI ¼ 0.65–0.90 ICC ¼ 0.79, 95% CI ¼ 0.60–0.89 ICC ¼ 0.40#, 95% CI ¼ 0.14–0.68 ICC ¼ 0.75, 95% CI ¼ 0.53–0.89 ICC ¼ 0.79, 95% CI ¼ 0.60–0.89 ICC ¼ 0.91, 95% CI ¼ 0.83–0.95 ICC ¼ 0.96, 95% CI ¼ 0.92–0.98 8/9


Table VII. Summary of reliability patterns across common sections of the ‘Computer User Profile’ and the ‘Adapted Compter User Profile’ for participants with and without TBI. Number of items with substantial-to-excellent reliability Adults with TBI

Adults without TBI (controls)

6 30

6/6 18/30

6/6 23/30

34 for adults with TBI, 33 for controls 70 for TBI; 69 for controls

30/34

32/33

54/70 (77%)

61/69 (88%)

Section

Aspect addressed

Questions

Total number of items

I II

Demographics Social communication and leisure activities Computer and Internet use/ activities

1–6 1–4 1–11

III (controls)/ IV (TBI) Total

21

TBI, Traumatic Brain Injury.

and chatrooms. Responses to these items were in the form of a rating on a 7-point likert scale. In this question, adults with TBI had seven out of nine items with substantial to high reliability (Table VI). Adults without TBI had eight out of nine items with substantial-to-high reliability in this question (Table VI). Overall survey reliability The CUP [4] and the Adapted CUP did not have a cumulative scoring system or grand total that tallied responses provided

by participants. A table was constructed to demonstrate the pattern of reliability for items across the three sections of the original and adapted versions of the CUP [4] (Table VII). Participants were most reliable in reporting demographic information in Section I, the frequency of their social communication and leisure activities in the first part of Section II and their computer/Internet habits in Section III. Participants were not as reliable in reporting their mode and frequency of communication with people living within close proximity and further away in Section II, but adults without TBI were far more reliable in these items compared with

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adults with TBI (Table VII). When reliability coefficients for all survey items were tallied and examined, adults with TBI were reliable in 77% of their T1 and T2 responses to survey items and adults without TBI were reliable in 88% of their T1 and T2 responses to survey items (Table VII). Hence, adults without TBI had the most reliable reports overall in administrations of the survey.


Discussion There were two aims of this paper. The first aim was to describe how the Computer User Profile (CUP) [4] could be adapted for use with a non-injured population. A description of the Adapted CUP appeared in the method and it involved removing a section of injury-related items. Consequently, there is now a version of the CUP which can be used to explore computer and Internet use as well as social communication and leisure activities of people without cognitive and TBI-related impairments. The second aim was to determine test–re-test reliability of items in the original and adapted versions of the CUP when used by adults with and without TBI. The reliability of survey items was assessed for a group of 16 adults with moderate-to-severe TBI and a group of 40 adults without TBI. The original and adapted versions of the CUP have satisfactory test–re-test reliability measures, with control participants demonstrating that they were able to achieve reliability across more items than people with TBI. Section I All participants were able to provide reliable responses to items asking for demographic information in Section I. Adults with TBI were also able to provide reliable injury-related information in Section III of their surveys. Since this information was personally relevant and familiar to participants, it was not surprising that responses were reliable. People with TBI are known to perform much better in tasks centred around personally meaningful activity or information compared with unfamiliar and artificial tasks [20–22]. Additionally, demographic items (for example, level of education, living arrangements) and injury-related information had structured choices, which may have guided participants to answer the questions more reliably. Clearly the layout, structure and content of this section may have facilitated more reliable responses in this section, which is a positive feature of the survey, especially for people with TBI and cognitive impairments. Section II In Question 1 of Section II, participants reliably rated how often they engaged in most social communication and leisure activities outlined in the survey Many adults without TBI were employed and maintained permanent jobs or had set university timetables, which may have enabled them to more reliably appraise their routines for the week including social communication and leisure activities. Similarly, adults with TBI may have used their daily or weekly routines to inform their responses to items in Question 1 of Section II, which resulted in more reliable appraisal of how often they engaged in social communication and leisure activities. The only item

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where reliability of adults with TBI was weaker related to their perceived quantity of volunteer work. The concept of volunteer work or amount of participation in this activity may not have been part of regular knowledge or routines of adults with TBI and, thus, may have impacted on the reliability of their responses to this item. Perhaps in future uses of the survey, items like ‘going to therapy’, ‘taking a class’, ‘playing board games’ and ‘doing volunteer work’ may be removed to improve reliability in future use of the survey. These items are very specific and they may not be common or applicable to many participants’ lifestyles. For the remainder of Section II, adults with TBI had less items with satisfactory reliability compared with adults without TBI (Table III). All participants were able to reliably identify communication partners living within close proximity and further away from them. Adults with TBI were not reliable with reporting the frequency of communication with people living further than an hour away from them (Question 3), which was not surprising given that the type and the frequency of their contact with these people may have been more variable and, thus, less familiar. However, adults with TBI were able to rate the frequency of face-to-face contact, phone contact, email use and chatroom meetings with communication partners living within close proximity to them with satisfactory reliability. This may be attributable to adults with TBI having a set routine for seeing and communicating with people living within close proximity in person and via the computer (Question 2). In Question 4 of Section II, participants were asked to indicate reasons for email and chatroom use for contacting people and professionals as well as for making business or event enquiries. All participants (adults with and without TBI) had poor reliability in rating these reasons for email and chatroom use. Perhaps in future uses of this survey, categories indicating the various purposes for emails and chatrooms could be removed or collapsed to more narrow choices to improve reliability of responses. Section III/IV (of the adapted and original CUP) Adults without TBI had perfect reliability for the first 10 questions of Section III/IV, which asked about computer/ chatroom capabilities and typing habits. Adults with TBI were not able to reliably report their typing habits or ownership of a computer (Questions 6–8). These participants may have had variable ownership or access to computers depending on where they lived (at home vs in a group facility), thus affecting their ability to reliably report on these topics. Adults with TBI were also unable to reliably rate their typing habits, even though they all reported having slower typing habits. Adults with TBI possibly were not aware about the distinction in slower typing habits, one being more of a motor difficulty relating to hunting and pecking at the keys and the other being more of a cognitive difficulty in having to scan and remember the placement of keys [3, 4]. None of the participants with TBI indicated that they could type without looking at the keyboard. In future uses of the survey, it may be worthwhile asking participants to rate on a scale of 5 or more points how quickly and how easy it is for them to use a keyboard on a likert scale rather than (or in addition to) asking them to



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categorize their typing habits (for example, as demonstrated in a further adaptation of the CUP in Appendix 3). Additionally, asking participants to rate their ability to use a mouse or touch screen may be equally as important as rating their ability to use a keyboard, as many computer and Internet applications (and other digital or electronic technologies) require the use of the keyboard, mouse and or touchscreen (for example, as demonstrated in a further adaptation of the CUP in Appendix 3). In the final question of Section III/IV, the survey asked participants to rate how frequently they used the computer and Internet over the past 6 months with regard to nine activities. Adults with and without TBI were able to reliably rate the frequency of computer and Internet use for word processing and leisure or entertainment-based activities. These activities included playing games, downloading music and images and buying goods and services online. Adults with and without TBI were also reliable in rating the frequency of their use of computers and the Internet to access chatrooms, even though all participants reported no or very little use of chatrooms. Overall in this question, adults without TBI had more items with satisfactory reliability (eight out of nine) compared with adults with TBI (seven out of nine). Adults without TBI may have had jobs or study schedules requiring frequent computer and Internet use across a range of activities (for example, emailing, word processing, finding information). Adults with TBI were not reliable in their reports of the frequency of computer and Internet use for work and for emailing, which was not surprising because not all adults with TBI owned a computer or required a computer for work or social communication. Additionally, adults with TBI may have used the telephone or face-to-face communication more regularly than email for communicating with other people and, thus, the variability in email use from day to day and week to week for them may have impacted on the reliability of their responses to Question 11. Summary, limitations and future directions This study has provided item-by-item measures of test–re-test reliability for the original and adapted versions of the Computer User Profile (CUP) [4] for adults with and without TBI. This was the first instance of measuring reliability of the CUP, thus leading to the development of preliminary psychometric properties of the survey. There was a period of 2 weeks between T1 and T2 survey administrations, which is common in designs of research studies investigating the test–re-test reliability of health-related surveys and instruments [15, 16]. While this time frame is adequate for measuring test–re-test reliability of health-related surveys and instruments, larger time gaps between survey administrations in future psychometric studies of the CUP may provide more representative reliability measures of the survey over time. It is also important to acknowledge that sample sizes were small and limited only to adults with and without TBI in this study. The group of adults with TBI was representative of the moderate-to-severe population with TBI. In future studies, it is recommended that groups of adults with mild and severe TBIs are included to determine survey use and test–re-test

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reliability of these clinical groups. This is an important consideration because injury severity may impact on computer and Internet use as well as on the accuracy and reliability of responses to survey items. Furthermore, it is not known whether carers of people with TBI assisted them to complete surveys in this study. In the future, it may be worthwhile asking carers to indicate if they helped participants at one or more completions of the survey for two reasons: (1) to consider variability of ratings for TBI participants as being a consequence of one or more carers’ involvement in survey completion rather than being a consequence of TBI participants’ poor memory or lack of consistency at T1 and T2 survey administrations and (2) to encourage more timely completion of surveys, with input into helping participants with TBI to interpret and more accurately answer questions in the survey and or fill in information that TBI participants are unable to recall or provide. All participants who completed the surveys commented that the questions were generally easy to answer. Occasionally the participants sought clarification regarding what the questions were asking. Therefore, in clinical practice, it may be beneficial to complete the survey face-to-face with clients and their significant others. Additionally, there is scope to develop the survey beyond the focus of computer and Internet use to include questions about other digital and electronic technology for example, mobile phones and tablet technology. Digital and electronic communication forums on the computer, Internet and other technologies are being used widely in everyday activities [23, 24]. Since all of these media may increase social connectivity and communication options for people with and without TBI, it is appropriate to explore the access, use and familiarity of computer, Internet and other technological applications by people with TBI. The CUP was found to be a practical, useful and reliable tool for use with a clinical population. It also has potential for further development and use by therapists working with people with TBI and cognitive impairments when exploring computer and technology readiness and skills development in rehabilitation programmes.

Conclusion The Computer User Profile (CUP) [4] was practical, easy to use and valuable in capturing information about social, leisure, communication and computer and Internet habits of people with and without TBI. Future reliability studies on this survey with larger groups of adults with and without TBI could further validate reliability measures established in this paper, especially amongst different groups of people with TBI including teenagers and people with more mild and severe injury diagnoses. All participants were most reliable in reporting demographic information and information relating to computer skills such as reading notes off a screen, typing notes and revealing their ability to participate in chatrooms. Participants were less reliable in reporting the frequency of leisure activities that were not a part of their daily or weekly routines. Perhaps these types of items could be removed in future uses


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of the survey, depending on the purpose, context and audience receiving administration of the survey. Additionally, it may be valuable to include items relating to mouse and touch screen use in the questions that address keyboard use and typing habits. This may provide further insight into speed, familiarity and proficiency of navigation on the computer screen and also on tablet technology, especially for people with TBI (who may have reduced mobility or use of their upper limbs due to physical and or motor impairments). There appears to be scope to increase the breadth of information collected by the CUP so that information about use of other digital and electronic communication technologies can be collected in addition to information about the nature and frequency of computer and Internet use. Extending adaptations and content of the CUP may enrich its clinical value in assessment of computer, Internet and technology use of people with TBI and other clinical populations. Furthermore, it would enable clinicians to understand how to best support access and skill development of people who are interested in using particular aspects of the computer and other technologies for particular activities of daily living. This would provide valuable information on impairment variables, activity levels and participation aspects of rehabilitation for clinical populations, which is well aligned with constructs of the International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001) [25]. The CUP is, therefore, an excellent resource (now with established reliability measures) for a number of health professionals, including Speech Pathologists and Occupational Therapists, who are involved with cognitive, sensorimotor, communication and psychosocial rehabilitation programmes.

Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

References 1. Hauber RP, Vesmarovich S, Dufour L. The use of computers and the Internet as a source of health information for people with disabilities. Rehabilitation Nursing 2002;27:142–145. 2. Magnan SS, editor. Mediating discourse online. Amsterdam/ Philadelphia: John Benjamins Publishing Company; 2008. 3. Vaccaro M, Hart T, Whyte J, Buchhofer R. Internet use and interest among individuals with traumatic brain injury: a consumer survey. Disability and Rehabilitation: Assistive Technology 2007;2:85–95. 4. Todis B, Sohlberg M, Fickas S, Hood D. Making electronic email accessible: perspectives of people with acquired cognitive impairments, caregivers and professionals. Brain Injury 2005;19:389–401. 5. Tsaousides T, Matsuzawa Y, Lebowitz M. Familiarity and prevalence of Facebook use for social networking among individuals with traumatic brain injury. Brain Injury 2011;25:1155–1162.

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6. Hellawell DJ, Taylor R, Pentland B. Cognitive and psychosocial outcome following moderate or severe traumatic brain injury. Brain Injury 1999;13:489–504. 7. MacDonald S, Johnson CJ. Assessment of subtle cognitivecommunication deficits following acquired brain injury: a normative study of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES). Brain Injury 2005;19:895–902. 8. Miotto E, Cinalli F, Serrao V, Benute G, Lucia M, Scaff M. Cognitive deficits in patients with mild to moderate traumatic brain injury. Arquivos de Neuro-Psiquiatria 2010;68:862–868. 9. Skandsen T, Finnanger T, Andersson S, Lydersen S, Brunner J, Vik A. Cognitive impairment 3 months after moderate and severe traumatic brain injury: a prospective follow-up study. Archives of Physical Medicine & Rehabilitation 2010;91:1904–1913. 10. Yaffee, R. (1998). New York: Statistics and Social Sciences group. Enhancement of Reliability Analysis: Applications of the Intraclass Correlation with SPSS v 8. [Website]. Available online at http:// www.nyu.edu/acf/socsci/Docs/intracls.html, accessed 20 November 2009. 11. Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. Journal of Chronic Diseases 1987;40:171–178. 12. Nunnally J. The assessment of reliability psychometric theory. New York: McGraw-Hill Book Company; 1967. p 248–292. 13. Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174. 14. Walter S, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Statistics in Medicine 1998;17:101–110. 15. Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. Journal of Clinical Epidemiology 2003; 56:730–750. 16. McDowell I, Newell C. Assessing reliability measuring health: a guide to rating scales and questionnaires. 2nd ed. Oxford University Press, Inc.; 2006. p 37–42. 17. SPSS Inc. SPSS Version 14.0 for Windows (Version III). Chicago, IL: SPSS Inc.; 2005. 18. Weir J. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. Journal of Strength & Conditioning Research 2005;19:231–234. 19. Schuck P. Assessing reproducibility for interval data in healthrelated quality of life questionnaires: which coefficient should be used? Quality of Life Research 2004;13:571–586. 20. Cherney LR, Shadden BB, Coelho CA. Analyzing discourse in communicatively impaired adults. Gaithersburg, MD: Aspen Publishers; 1998. 21. Tu L, Togher L, Power E. The impact of communication partner and discourse task on a person with traumatic brain injury: The use of multiple perspectives. Brain Injury 2011;25:560–580. 22. VanLeer E, Turkstra L. The effect of elicitation task on discourse coherence and cohesion in adolescents with brain injury. Journal of Communication Disorders 1999;32:327–349. 23. Morris J, Mueller J, Jones M. Toward mobile phone design for all: Meeting the needs of stroke survivors. Topics in Stroke Rehabilitation 2010;17:353–361. 24. Wanner A. Mediating discourse online. In: Magnan SS, editor. AILA Applied Linguistics Series 3. Amsterdam/Philadelphia: John Benjamins Publishing Company; 2008. p 125–149. 25. World Health Organization. (2001). ICF: International classification of functioning, disability and health. Geneva: World Health Organization.


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Appendix 1. Modified ‘Computer User Profile’ [4] for participants with TBI Name and email address: ____________________________________________________________________________________________________


Section I

œ female

1 2 3

Gender: Age: Education:

4 5 6

Where do you live? People living in your home? Do you go to Speech Pathology? If Yes: How many hours per week?

œ œ œ œ œ œ œ

œ male

Pre-school œ HSC Primary school œ TAFE Year 7, 8, 9, 10 œ University home/apartment œ assisted living facility parents œ brother/s œ sister/s œ roommate œ other yes œ no 1 œ 5 œ 5–10 œ over 10

Section II 1. Approximately, how often did you do the following activities in the last month? (CHECK ONE BOX FOR EACH ITEM)

a b c d e f g j k l m n

Spend time with friends Talk on the phone with friends or relatives Play sport Play cards or board games with others Do volunteer work Take a class Go to therapy Spend time reading a book, magazine or newspaper Watch TV Play a video or computer game Use the computer/Internet Go on Internet chatrooms

1 Several times a day

2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7

œ œ œ œ œ œ œ œ







œ œ œ œ

œ œ œ œ

œ œ œ œ

œ œ œ œ

œ œ œ œ

œ œ œ œ

œ œ œ œ

Never

2a. Select one person who is important to you that you keep in contact with who lives within 1 hour (driving time) from you.

œ Girlfriend/boyfriend œ Friend

œ Relative œ Carer/ therapist

2b. How frequently do you communicate with this person? Use the table below.

a b c d e

In person Telephone Electronic mail (email) Written notes Internet chatroom


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

Never

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3a. Select one person who is important to you that you keep in contact with who lives more than 1 hour (driving time) from you.





a b c d e



2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

4. For what purposes would you use email and chatrooms?

œ contact family œ contact friends

œ meet new people œ inquire about business/organizations

œ contact professionals œ plan an event

Section III 1. How long ago was your first brain injury? 2. How did first brain injury occur? œ œ œ œ

œ œ œ œ

illness/tumour motor vehicle crash assault/abuse pedestrian/bicycle accident

weapons accident fall drugs/medications heart attack

œ drowning œ stroke/aneurysm œ Other

3. Length of initial hospitalization? œ œ œ œ

œ œ œ œ

went home same day 1–2 days 3–7 days 1–4 weeks

1–3 months 3–6 months If over 6 months, how long? Don’t know

4. Estimate length of coma.

œ none œ 1–2 weeks

œ 1–3 days œ 2–4 weeks

œ 4–6 days œ more than 1 month

5. Primary cognitive impairment (you can ask someone for help with this question).

œ œ œ œ

memory planning/organization language (reading/writing) limited self-awareness

œ attention œ problem-solving œ impulsivity

6. Sensory impairment.

œ vision œ touch/temperature

œ hearing œ other/explain

œ initiation œ visuoperceptual processing œ error detection/correction

Never


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7. Motor impairment.

œ difficulty ambulating œ reduced hand/finger use

œ right hemiplegia œ left hemiplegia

œ movement/co-ordination œ other/explain

8. Emotional issues.

œ restlessness

œ anger

œ sadness

œ reduced self-esteem

œ anxiety

œ loneliness

œ fear


Section IV 1 2 3 4 5 6 7 8

Used computer before your injury? Used computer following your injury? Do you currently own a computer? Are you able to read a short, type-written note? Are you able to write (compose) a short, type-written note? Do you go on Internet chatrooms? Are you able to participate in Internet chatrooms? When you use the keyboard do you:

9

Is there someone available to help you if you want to use a computer?

œ œ œ œ œ œ œ œ œ œ

yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no hunt and peck/one finger œ type but need to look at all the keys type without looking much at keyboard yes œ no

10. If you are not using a computer, why not?

œ œ œ œ œ

financial motor problems visual problems hand–eye problems access issues

œ œ œ œ œ

it is too complicated takes too long feel intimidated not interested other

11. If you are not using Internet chatrooms, why not?

œ don’t have a computer œ not allowed at home/school œ other

œ it is too complicated œ takes too long

œ feel intimidated œ not interested

12. In the past 6 months, how frequently have you used a computer or the Internet for the following purposes?

a b c d e f g h i

Word processing Organization (schedule, reminders) Work Games Finding information Buying a product or service Downloading (music, images, etc.) Email Chatrooms


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7

œ œ œ œ œ œ œ œ œ







Never

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Appendix 2. Adapted Computer User Profile (based on Todis et al. [4]) for control participants Name and email address: ____________________________________________________________________________________________________


Section I

œ female

1 2 3


4 5 6



œ male



a b c d e f g j k l m n

Spend time with friends Talk on the phone with friends or relatives Play sport Play cards or board games with others Do volunteer work Take a class Go to therapy Spend time reading a book, magazine or newspaper Watch TV Play a video or computer game Use the computer/Internet Go on Internet chatrooms


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7 Never

œ œ œ œ œ œ œ œ œ œ œ œ







2a. Select one person who is important to you that you keep in contact with who lives within 1 hour (driving time) from you. œ Girlfriend/boyfriend œ Friend

œ Relative œ Carer/therapist


a b c d e



2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

3. Select one person who is important to you that you keep in contact with who lives more than 1 hour (driving time) from you.



Never


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a b c d e



2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

œ œ œ œ œ

Never



œ contact family œ contact friends

œ meet new people œ inquire about business/organizations

œ contact professionals œ plan an event

Section III 1 2 3 4 5 6 7 8

Used computer before your injury? Used computer following your injury? Do you currently own a computer? Are you able to read a short, type-written note? Are you able to write (compose) a short, type-written note? Do you go on Internet chatrooms? Are you able to participate in Internet chatrooms? When you use the keyboard do you:

9

Is there someone available to help you if you want to use a computer?


yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no hunt and peck/one finger œ type but need to look at all the keys type without looking much at keyboard yes œ no

10. If you are not using a computer, why not?

œ œ œ œ œ

financial motor problems visual problems hand–eye problems access issues

œ œ œ œ œ

it is too complicated takes too long feel intimidated not interested other

11. If you are not using Internet chatrooms, why not?

œ don’t have a computer œ not allowed at home/school œ other

œ it is too complicated œ takes too long

œ feel intimidated œ not interested


a b c d e f g h i

Word processing Organization (schedule, reminders) Work Games Finding information Buying a product or service Downloading (music, images, etc.) Email Chatrooms


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7








Never

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Appendix 3. Potential extension of the Computer User Profile (based on Todis et al. [4]) to include other items relating to technology navigation and use for participants with TBI Name and email address: ____________________________________________________________________________________________________


Section I

œ female

1 2 3


4 5 6



œ male



a b c d e f g j k l

Spend time with friends Talk on the phone with friends or relatives Play sport Play cards or board games with others Go to therapy Spend time reading a book, magazine or newspaper Watch TV Play a video or computer game Use the computer/Internet Go on Internet chatrooms


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7








7

Never

2a. Select one person who is important to you that you keep in contact with who lives within 1 hour (driving time) from you.


œ Relative œ Carer/therapist


a b c d e f g

In person Telephone Email Written notes/letters Chatroom Other e-communication, e.g. Facebook Other phone contact, e.g. SMS


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

Never








3a. Select one person who is important to you that you keep in contact with who lives more than 1 hour (driving time) from you.




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a b c d e f g

In person Telephone Email Written notes/letters Chatroom Other e-communication, e.g. Facebook Other phone contact, e.g. SMS


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

Never










œ contact family/friends

œ meet new people

œ contact professionals/businesses

Section III 1. How long ago was your first brain injury? 2. How did first brain injury occur? œ œ œ œ

œ œ œ œ

illness/tumour motor vehicle crash assault/abuse pedestrian/bicycle accident

weapons accident fall drugs/medications heart attack

œ drowning œ stroke/aneurysm œ Other

3. Length of initial hospitalization?

œ œ œ œ

went home same day 1–2 days 3–7 days 1–4 weeks

œ œ œ œ

1–3 months 3–6 months If over 6 months, how long? Don’t know

4. Estimate length of coma.

œ none œ 1–2 weeks

œ 1–3 days œ 2–4 weeks

œ 4–6 days œ more than 1 month

5. Primary cognitive impairment (you can ask someone for help with this question).

œ œ œ œ

memory planning/organization language (reading/writing) limited self-awareness

œ attention œ problem-solving œ impulsivity

6. Sensory impairment. œ vision œ touch/temperature

œ hearing œ other/explain

œ initiation œ visuoperceptual processing œ error detection/correction

7

1290

A. M. Kilov et al.

Brain Inj, 2015; 29(11): 1273–1291

7. Motor impairment.

œ difficulty ambulating œ reduced hand/finger use

œ right hemiplegia œ left hemiplegia

œ movement/co-ordination œ other/explain

8. Emotional issues.

œ restlessness

œ anger

œ sadness

œ reduced self-esteem

œ anxiety

œ loneliness

œ fear

Section IV


9. Computer and internet use

a b c d e f g h i j k l m n

Did you use a computer before your injury? Have you used a computer after your injury? Do you currently own a computer? Are you able to read a short, type-written note? Are you able to write (compose) a short, type-written note? Do you use emails? Are you able to write and send emails? Do you use the Internet? Are you able to use the Internet? Do you go on Internet chatrooms? Are you able to participate in Internet chatrooms? What other social networks do you use on the Internet? Are you able to use a mouse? When you use the keyboard do you:

o

Rate how easy it is for you to use a keyboard for typing

p

Rate how quickly you are able to use a keyboard for typing

q r

Are you able to see text and graphics on the computer screen? Do you need someone to help you use the computer/Internet?

10a. If you are not using a computer, why not?

œ œ œ œ

financial motor problems visual problems hand–eye problems

œ œ œ œ

it is too complicated not interested access issues other

10b. If you are not using Internet chatrooms, why not?

œ don’t have a computer œ not interested

œ it is too complicated

œ feel intimidated

œ œ œ œ œ œ œ œ œ œ œ œ œ œ œ

yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no yes œ no Facebook, œ Twitter, œ MSN messenger yes œ no hunt and peck (1 finger) œ type but need to look at keys type without looking much at the keyboard

œ yes œ yes

œ no œ no


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a b c d e f g h i

Word processing Organization (diary/reminders) Work Games Finding information Buying a product or service Downloading (e.g. music) Email Chatrooms


2 About once a day

3 3–5 days a week

4 1–2 days a week

5 Every few weeks

6 Less often

7








Never


Section V 1. Other digital/electronic technology and communication

a b c d e f g h i

Did you use a mobile phone before your injury? Have you used mobile phone after your injury? Do you currently own a mobile phone? Do you use SMS on your mobile phone? Are you able to write and send an SMS on your phone? Do you have a Blackberry? Do you have an I-Phone or Smartphone? Are you able to use a Blackberry/Smartphone? Rate how easy it is for you to use your phone for making calls, typing messages, etc.

j

Rate how quickly you are able to use your phone for making calls, typing messages, etc.

k l m n o

Do you need someone to help you use your mobile phone? Did you use an I-Pad before your injury? Have you used and I-Pad after your injury? Do you currently own an I-Pad? Are you able to use a touch screen? Rate how easy it is for you to use your I-Pad for games, emails and other applications

p

Rate how quickly you are able to use your I-Pad for games, emails and other applications

q

Do you need someone to help you use your I-Pad?


yes yes yes yes yes yes yes yes


no no no no no no no no

œ œ œ œ œ

yes yes yes yes yes

œ œ œ œ œ

no no no no no

œ yes

œ no

The Internet and Computer User Profile: a questionnaire for determining intervention targets in occupational therapy at mental health vocational centers.

Computer technology in brain injury.

Psychometric properties of the college survey for students with brain injury: individuals with and without traumatic brain injury.

Reliability, Validity, and Feasibility of a Computer-Based Geriatric Assessment for Older Adults With Cancer.

Brain-computer interface after nervous system injury.

A Novel Computer Oculomotor Rehabilitation (COR) Program for Mild Traumatic Brain Injury (mTBI).

Reliability of brain-computer interface language sample transcription procedures.

Common biochemical defects linkage between post-traumatic stress disorders, mild traumatic brain injury (TBI) and penetrating TBI.

Predicting long-term outcome following traumatic brain injury (TBI).

Traumatic brain injury: PET imaging detects amyloid deposits after TBI.

Quantifying electrode reliability during brain-computer interface operation.

Novel computer tests for identification of mental fatigue after traumatic brain injury.

Depression in Men and Women One Year Following Traumatic Brain Injury (TBI): A TBI Model Systems Study.

Towards user-friendly spelling with an auditory brain-computer interface: the CharStreamer paradigm.

Behavioral scales used in severe and moderate traumatic brain injury.

Future of traumatic brain injury in adults.

The reliability, validity, and feasibility of physical activity measurement in adults with traumatic brain injury: an observational study.

Neurotrauma and Repair Research: Traumatic Brain Injury (TBI) and its Treatments.

Spectral Transfer Learning Using Information Geometry for a User-Independent Brain-Computer Interface.

Mental Health Implications of Traumatic Brain Injury (TBI) in Children and Youth.

Executive functioning and suicidal behavior among veterans with and without a history of traumatic brain injury.

Traumatic brain injury: age at injury influences dementia risk after TBI.

The impact of pediatric traumatic brain injury (TBI) on family functioning: a systematic review.

The negative impact of traumatic brain injury (TBI) on bone in a mouse model.