Assistive Technology

and Traumatic Brain Injury

• The views expressed in this presentation are those of the authors and do not reflect the official policy of the Department of the Navy, Army, or Air Force, the Department of Defense, nor U. S. Government.

• This presentation does not imply any Federal / DOD endorsement.

Disclosure

• VA Central Office Contract to the University of Pittsburgh to provide support to VA Polytrauma Centers for Assistive Technology

A Review:Assistive Technology Device

“…any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” (Assistive Technology Act of 1998)

The AT Team Includes:• **The Individual** • Case Managers• Nurses• Occupational Therapists• Physical Therapists• Physicians• Psychologists• Speech Language Pathologists• Therapeutic Recreation Specialists• Vision Rehabilitation Specialists• …and many more!

AT Pyramid

Developed at Pennsylvania’s Initiative on Assistive Technology (Dolloff and Reinsfelder, 2010)

Low

Mid

High

Examples of AT

• Low tech – Pen and paper, Stylus, (Slim Jim or String Cheese?)

• Mid tech– Pagers, Alarms, Simple vibrating watches

• High tech– Automated systems / Reminders– Smart phones and Tablets– (Are these really “high tech” anymore?)

AT Services: The Other Half

• Evaluation for appropriate devices and selection of device.

• Coordination with service providers (e.g., therapists, engineers).

• Training / technical assistance for the person and supporting individuals (e.g., personal assistants).

• Follow up

HAAT Model

Cook and Hussey’s Assistive Technologies: Principles and Practice

HAAT Model(Simplified)

• Human• Activity

• Assistive TechnologyAND

• Environment (context)

Time Management / Organization• Low Tech

– Sticky notes– Pre-organized books/folders– Data planners– Alarms / timers

• Computer based reminders• Online Tools• Paging systems / services• PDA's / Cell Phones

Time Management / Organization

iPhone

Talking Watch

Paper Calendar

Thought Organization

• Dragon Naturally Speaking • Windows Speech Recognition

– (only available in Windows 7 and more recent versions)

• WordQ / SpeakQ• Word Prediction

Thought Organization

• Claro Read• DraftBuilder• Inspiration• Read and Write Gold

• Kurzweil 3000• WYNN• Mindview

Information Processing / Comprehension

• Text to Speech

• Some magnification software programs also highlight as they read

Speech to Text Examples:

Captioned Telephone www.captel.com

Real Time CaptioningPhoto from: http://webaim.org/techniques/captions/realtime

Speech to Text

Example:Google Voicemail Transcription

Video:

http://www.youtube.com/watch?v=fHuai7-jVlY&feature=player_embedded

Photo taken from: http://www.google.com/support/voice/bin/answer.py?answer=115986

Memory• Internet Calendars

– Color code and organize calendars and appointments

– Can share with a caretaker using the same server

• Task lists– Paper and pencil, or as an app

• Recording devices• Zomm

Headsets for Concentration

Microsoft LiveChat Headset with microphone

ATH-ANC27 QuietPoint® Active Noise-cancelling Headphones

Communication• Physical separate device dedicated to

communication• Examples:

Dynavox EyeMax Tobii ATI C12

Communication

• Using technology the person may already have

• Examples:NeoSpeech Paul or Kate

Proloquo 2 Go

VisionApple Universal Access

Bump DotsPhoto taken from: www.maxiaids.com

VelcroPhoto taken from: www.velcro.com

Vision ExamplesCopolillo A, Ivanoff SD. (2011) Assistive Technology and Home Modification

for People with Neurovisual Deficits. NeuroRehabilitation 28: 211-220. DOI 10.3233/NRE-2011-0650

• Neurovisual Deficits are different from progressive eye diseases (macular degeneration, etc)

• Decreased control of eye movement, double vision, sensitivity to light, decreased cognitive skills and incorrect perception of the environment

• Correct balance between independence and safety.

Vision Examples (con’t)Copolillo A, Ivanoff SD. (2011) Assistive Technology and Home Modification

for People with Neurovisual Deficits. NeuroRehabilitation 28: 211-220. DOI 10.3233/NRE-2011-0650

• Proper lighting in the home (incandescent)• Automatic lights (motion sensors)• Color filters• Contrast (furniture, rugs, walls, steps)• Magnifiers with lights or OCR• Read – along highlighting• Talking Clocks

Magnification and Audio

Telesensory Desktop CCTV

Victor Reader Stream

Assistive Listening

GPS Ranger

LES705 Amplification system

Induction Loop ClipBoardLES 370 Personal FM System

Noise Cancelling Headphones

Navigation Example• Lemoncello, R., Moore Sohlberg, M., & Fickas, S. (2010). When directions

fail: Investigations of getting lost behavior in adults with acquired brain injury. Brain Injury, 24 (3):550-559. Doi: 10.3109/02699050903446807

• 18 adults with acquired brain injury with 18 matched controls

• Problems: impulsivity, lack of planning, memory lapses and anxiety

• Aids: written directions, standard cell phone connected to a “helper”

Navigation Example (Con’t)

• Those with brain injury had more errors, and used more vague descriptions of current locations when calling for help.

• Cell phone was useful for reorientation and reassurance

• Suggest navigational tools should also provide reassurance to travelers they guide

Universal Design

Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.–Ron Mace http://www.ncsu.edu/www/ncsu/design/sod5/cud/about_ud/about_ud.htm

Examples:– Audio descriptions– Captioning– Simplified interfaces

Video -

GPIIhttp://www.gpii.net/

Newer Opportunities for AT

Time Management & Organization

Paging systems - software– SMS – short message service– MMS – multimedia messaging service– Computer based– Send messages to cell phone– Google

Time Management & Organization General PDA's (soon to be outdated?)

– Windows• Asus My Pal, Pharos, HP IPAQ

– MAC• I-touch

Smart Phones– Windows, MAC, Android, Blackberry, Nokia

Symbian OS, Palm Web OS

Time Management & organization

PDA’s / cell phones advantages – Alert/Prompts – sound/vibration– Search– More information– Information carries over – easier to change– Link calendar + contacts– Notes / To-Do’s– Link to PC/Internet – 2 copies –

synchronized– Copy and paste from computer

Time Management & Organization• PDA’s / cell phones advantages

– Looks “Normal” / the “cool factor”– Basic models serve many cognitive

needs– PDA Software add-ons and Apps

• Dictionary • Spelling / Irregular Verbs• Word prediction• GPS• Cameras• Messaging

iPad / Samsung Galaxy Pad

Zoom / Streak / Playbook

E-readers

• E-Ink vs. Color screens• E-readers with text to speech on some books • E-readers with calendar feature

Examples of EvidenceDowds MD, Lee PH, Sheer JB, O’Neil-Pirozzi TM, Xenopoulas-Oddsson A, Goldstein

R, Zainea KL, Glenn MB.(2011). Electronic Reminding Technology Following Traumatic Brain Injury: Effects on Timely Task Completion. J Head Trauma Rehabilitation. 1-9.

• 36 Adults with a Traumatic Brain Injury were asked to complete tasks using 4 memory strategies

• Those who used an electronic Personal Digital Assistant (PDA) had a higher success rate of completing the task over using paper and pencil alone

May mean…..

Traumatic Brain Injury

Other things to consider

• Trauma can also affect other abilities

– Vision– Hearing– Balance – Dexterity

Newer Technology

• Home monitoring systems• “Face Time” can help to facilitate contact• In development:

– Simplified digital scanners for warehouses– Cell phones programmed with cognitive

assistance and encouragement – activated when shaken

– “Context aware” devices • Ex. Voice prompts activated when entering a room

Other Technology

• Signlink Studio - www.signlinkstudio.com

Wayfinding for Individuals with DementiaGrierson, Lawrence E. M. , Zelek, John , Lam, Isabel , Black, Sandra E. and

Carnahan, Heather(2011) Application of a Tactile Way-Finding Device to Facilitate Navigation in Persons With Dementia, Assistive Technology, 23: 2, 108 — 115

• A belt is worn• Vibration cues occur in the direction the person

needs to go • Found the design to be helpful• Current design may not work in community settings • Are there implications for people with TBI?

Key Things to Remember

• No two people are alike• Each situation results in a unique solution,

application, or combination of tools• Thinking outside of the box is good! • Include the individual in the process• Avoid the temptation of trends• Follow up, Follow up, Follow up!!

Three Key Points

• Description of the desired activity (goals)• Individual’s history at it relates to the desired

activity (personal limitations)• Environment the task will most likely take

place in (context)

Remember the HAAT?

• No two individuals are the same– What works for one service member may not

work for the others with similar barriers

• There is no “wrong way” to use tools– If it was designed for one purpose but works to

accomplish another – great!

Assistive Technology is

Creativity!

Resources

• State AT Act Programs– www.ataporg.org

• Professional Organizations– Ex. RESNA, ATIA

• Your team!

Contact Information

Amanda Reinsfelder, ATPAmanda.reinsfelder@amedd.army.mil202-257-5756