The Effect of Choice on Compliance Using Telerehabilitation for Direct Attention Training: A Comparison of “Push” Versus “Pull” Scheduling Home practice, a type of asynchronous telerehabilitation, is an integral component of most rehabilitation regimens. Exercise drills conducive to home practice have been shown to be beneficial in remediating acquired impairments in attention, speech, language, and voice. A variety of interacting psychological, cognitive, and socioenvironmental factors contribute to short- and ... Article
Article  |   October 01, 2011
The Effect of Choice on Compliance Using Telerehabilitation for Direct Attention Training: A Comparison of “Push” Versus “Pull” Scheduling
Author Affiliations & Notes
  • McKay Moore Sohlberg
    Communication Disorders & Sciences, University of Oregon, Eugene, OR
  • Rik Lemoncello
    Speech & Hearing Sciences, Portland State University, Portland, OR
  • Jaime Lee
    Communication Disorders & Sciences, University of Oregon, Eugene, OR
  • McKay Moore Sohlberg is the Hedco Endowed Professor in the communication disorders and sciences program at the University of Oregon. Her work in developing and evaluating cognitive rehabilitation programs for adolescents and adults with brain injury is well known internationally. She has authored numerous journal articles, two leading texts in the field, and a number of widely used evidence-based clinical programs. Sohlberg has been the principal investigator on a number of funded projects developing methods to help people with chronic long-term impairments following brain injury integrate into the community, particularly through the use of assistive technology.
    McKay Moore Sohlberg is the Hedco Endowed Professor in the communication disorders and sciences program at the University of Oregon. Her work in developing and evaluating cognitive rehabilitation programs for adolescents and adults with brain injury is well known internationally. She has authored numerous journal articles, two leading texts in the field, and a number of widely used evidence-based clinical programs. Sohlberg has been the principal investigator on a number of funded projects developing methods to help people with chronic long-term impairments following brain injury integrate into the community, particularly through the use of assistive technology.×
  • Rik Lemoncello is assistant professor in speech and hearing sciences at Portland State University. His research and expertise focus on assistive technologies for adults with cognitive impairment due to acquired brain injury, specifically self-efficacy and motivation for use of technology. His work also focuses on evidence-based practices and graduate student training.
    Rik Lemoncello is assistant professor in speech and hearing sciences at Portland State University. His research and expertise focus on assistive technologies for adults with cognitive impairment due to acquired brain injury, specifically self-efficacy and motivation for use of technology. His work also focuses on evidence-based practices and graduate student training.×
  • Jaime Lee is a doctoral student at the University of Oregon and a clinical supervisor at the University of Oregon Speech-Language-Hearing Center. Jaime has worked as an inpatient rehabilitation clinician and has research experience in the utilization of computer technology to provide intensive therapy to individuals with aphasia. Her research interests include the investigation of evidence-based interventions for individuals with cognitive-communication and language disorders and the clinical applications of emerging technology.
    Jaime Lee is a doctoral student at the University of Oregon and a clinical supervisor at the University of Oregon Speech-Language-Hearing Center. Jaime has worked as an inpatient rehabilitation clinician and has research experience in the utilization of computer technology to provide intensive therapy to individuals with aphasia. Her research interests include the investigation of evidence-based interventions for individuals with cognitive-communication and language disorders and the clinical applications of emerging technology.×
Article Information
Telepractice & Computer-Based Approaches / Attention, Memory & Executive Functions / Articles
Article   |   October 01, 2011
The Effect of Choice on Compliance Using Telerehabilitation for Direct Attention Training: A Comparison of “Push” Versus “Pull” Scheduling
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, October 2011, Vol. 21, 94-106. doi:10.1044/nnsld21.3.94
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, October 2011, Vol. 21, 94-106. doi:10.1044/nnsld21.3.94

Home practice, a type of asynchronous telerehabilitation, is an integral component of most rehabilitation regimens. Exercise drills conducive to home practice have been shown to be beneficial in remediating acquired impairments in attention, speech, language, and voice. A variety of interacting psychological, cognitive, and socioenvironmental factors contribute to short- and long-term exercise adherence. There has been little research evaluating the personal characteristics most likely to motivate clients to engage in their rehabilitation and follow through with prescribed activities. In this project, we were interested in using telerehabilitation to learn more about factors that might increase clients' adherence to home exercise; we used direct attention training as our experimental domain. The study used a single-subject, alternating treatment experimental design with 2 participants to compare compliance on home attention exercises under two conditions. The Attention Process Training-3 (APT-3, 2010) direct attention training program, delivered via the Televised Assistance Program (TAP) system, allowed us to compare compliance under (a) conditions when the client had no control over the start-up of the program (push) versus (b) conditions when the client had to initiate turning on the program to do the home program (pull). Results showed that home exercise adherence was higher for both participants under the nonautonomous push condition. This ran counter to our hypothesis, based on the therapy literature, that suggested patients are more likely to follow through with home assignments when practice is under their control. We discuss our findings with respect to the interaction between self-efficacy, therapy beliefs, and autonomy for patients with acquired brain injury.

Acknowledgments
This study was supported by Grant H133S070076 from the U.S. Department of Education.
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