The longitudinal effects of accessible email for individuals with severe cognitive impairments

Background: Electronic communication has provided an unprecedented means of networking people for business, educational, and social purposes (eMarketer, 2001; Madden & Rainie, 2003). However, this mainstream form of communication remains largely inaccessible to individuals with severe cognitive-communicative disabilities (Elman, 2001; Lenhart et al., 2003). This report describes the longitudinal effects of using an adapted email interface by individuals with severe cognitive disabilities due to acquired brain injury.Aims: Research questions included: (1) Can people with severe cognitive impairments learn to email independently using an adapted interface? (2) If participants successfully learn to email, what types of supports are needed to maintain long-term use of email? (3) What, if any, are the psychosocial effects of long-term email participation?Methods & Procedures: A combination of qualitative and quantitative approaches was used to address the above questions for four participants with acquired brain injury, one female and three males, ranging in age from 37 to 65 years, all of whom reported significant social isolation due to their cognitive disabilities. Following assessment (e.g., mock email assessment, goal attainment scaling, neuropsychological testing), they were trained to use a simplified email program using an explicit instructional methodology. Weekly email statistic reports and activity logs were generated to measure frequency, efficiency, topic parameters, and satisfaction related to using email.Outcomes & Results: All four participants became independent, satisfied emailers in their home environments and continued to engage in social email after 9 months. The weekly metrics and email logs showed progressive improvements in efficiency, complexity of written expression, and range of topics discussed. All participants endorsed the social benefits of email and achieved the “most successful outcome” possible for several of their individual goals, including learning a new skill, feeling more connected with friends and family, and increasing their list of email partners.Conclusions: This study is one of the first longitudinal reports on the use of assistive technology by people with severe acquired cognitive impairments, and demonstrates the potential of adapted email as a means of increasing their social communication with friends and family. Issues related to the need to decrease the intensity of human support required to establish long-term use of assistive technology are discussed.