(Bergquist et al. 2008; Diamond et al. 2003; Melton and Bourgeois 2005), or the etiology of the brain injury of participants was not specified as traumatic (Soong et al. 2005). Studies included in the telehealth technology review are not mutually exclusive from trials included in the evaluations of other domains.

Of the remaining five studies, one was a small, randomized crossover study that involved 20 volunteers with a history of moderate-severe traumatic brain injury (TBI) at least 1 year prior to study entry (Bergquist et al. 2009, 2010). Individuals with a history of ongoing psychiatric symptoms were included as long as symptoms were not severe (e.g., psychotic symptoms). Participants, who had to have reliable access to the Internet, were randomized to an active cognitive rehabilitation intervention or to a control group. After completing 30 instant messaging sessions with online therapists, participants were crossed over to the alternate group for 30 more sessions. The active intervention, which involved an online occupational therapist with expertise in cognitive rehabilitation, focused on developing calendar skills to address difficulties with memory in everyday life and on developing strategies to improve memory functioning. The control group also involved interaction with the online therapist, but participants in this group were instructed primarily to use their calendar to record day-to-day events rather than using calendars as a compensatory tool for memory impairments. Only 14 participants completed the study. Outcome measures were self-reported measures that assessed use of compensation strategies (Compensation Techniques Questionnaire) and satisfaction with therapy, and measures completed by family members (Neurobehavioral Functioning Inventory and Compensation Integration Questionnaires). All participants reportedly learned to use the instant messaging system. Most individuals in both groups were satisfied with their Internet-based interventions. No statistically significant differences in change in daily function were reported between groups after 30 sessions.

Another modest-sized trial involved adults with persisting memory problems several years after a documented closed head injury (Bourgeois et al. 2007). The trial also required a family member to participate with the patient. Participant-caregiver pairs were assigned to either spaced retrieval training or a didactic control strategy using stratified pairing based on race and sex (quasi-experimental). Both treatments were delivered via telephone by clinician trainers. After initial face-to-face assessments of cognitive difficulties and social participation activities, the trained discussed treatment goals with the client and caregiver, and the group selected the three most troublesome areas to work on during training. The trainer then provided memory logs and asked patients and caregivers to record the frequency with which each problem occurred over the next week. The trainer called participants the following day to make sure that instructions and data collection



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