Tailoring cognitive assistance for individuals with a traumatic brain injury using assistive technology for cognition: translating clinical reasoning into ontologies

Individuals with a traumatic brain injury (TBI) frequently require cognitive assistance to engage in complex activities, emphasising the need for personalised support to enhance their independence. This study explored how occupational therapists use evaluation results to tailor cognitive assistance and translated these results into clinical reasoning ontologies that could be integrated into assistive technologies for cognition (ATCs). Fifteen occupational therapists and occupational therapy master’s students participated in focus groups presenting case studies of clients with moderate to severe TBI. Participants were asked how they would adapt cognitive assistance provided during interventions based on evaluation results and client characteristics. Thematic analysis was employed. Clinical reasoning ontologies were developed in interdisciplinary team meetings. Analysing clients’ behaviours and the assistance provided during an Activities of Daily Living evaluation, participants determined the minimum cognitive assistance required for clients to progress in their tasks. Therapists suggested using evaluation results to inform initial cognitive assistance while also considering task characteristics, the intervention session goal and the treatment approach. Adjustments were made to progress the assistance by observing difficulties and responses to assistance during both individual sessions and across multiple sessions. The ontology represents a customisable assistance model, allowing cognitive assistance to evolve according to the context and the user profile. This study presents ontologies reflecting the clinical reasoning used by occupational therapists to tailor cognitive assistance during interventions for individuals with a TBI. Further work is needed to enable the implementation of these clinical reasoning ontologies into ATCs. Occupational therapists adapt the initial cognitive assistance they provide during the intervention phase based on the minimal required cognitive assistance for task completion, and adjust it according to task difficulty and treatment session objectives.Post-task feedback is key in supporting the adjustment of cognitive assistance across sessions.Using the developed ontology, assistive technologies for cognition could be developed to provide progressive and personalised assistance both during one session and across sessions. Occupational therapists adapt the initial cognitive assistance they provide during the intervention phase based on the minimal required cognitive assistance for task completion, and adjust it according to task difficulty and treatment session objectives. Post-task feedback is key in supporting the adjustment of cognitive assistance across sessions. Using the developed ontology, assistive technologies for cognition could be developed to provide progressive and personalised assistance both during one session and across sessions.