Assistive Technology Cognitive Disabilities...Take-aways from today: Focus is NOT on technology –AT should always support functional activities Both cognitive status (patient) and

Assistive Technology

for

Cognitive Disabilities

Overview

Description of our context for cognitive AT

Models of cognition and engineering design

Devices and systems

– Time Management and Organization

– Thought Organization

– Computer Utilization Aides

Virtual Reality

Emerging possibilities for Behavioral/Emotional

regulation

Take-aways from today:

Focus is NOT on technology – AT should

always support functional activities

Both cognitive status (patient) and

engineering design play a role in good AT

AT is not discipline-specific

Technology has strengths but also

drawbacks and limitations

VA has developed Clinical Practice

Guidelines

RST Cognitive AT: Two Sites

University of

Pittsburgh Medical

Center (UPMC)

Center for Assistive

Technology (CAT)

Interagency agreement to

provide clinical services at

Hiram G. Andrews Center, a

state-operated vocational

training program in Johnstown

– Center for Assistive and Rehabilitative Technologies (CART)

– Learning Technologies Program (LTP)

– Cognitive Skills Enhancement Program (CSEP)

CSEP – Program

15 week residential program

Daily classroom

Group and individual counseling

Vocational projects

Fund raising event

8 weeks mentorship

Mentorship banquet

Tier II (follow-up of grads) and Tier III

(consultation and indiv cog rehab)

Cognition – primary diagnoses

– Learning Disabilities (LD)

– Traumatic Brain Injury (TBI)

– Attention Deficit (ADHD)

– Autism Spectrum Disorders (ASD)

NOT primary mental health issues

– Bi-polar

– Depression

– Excludes Mental Retardation

CSEP - Participants

cognition

– Flexible thinking, problems solving

organization

– Projects, personal schedule

behavioral accountability

– Conflict resolution, listening to others

self and social awareness

– Other centeredness, personal appearance

CSEP – Goals

CSEP – Goals

self-esteem

goal setting

– personal, vocational

communication skills

– self advocacy, initiation

Cognition

Executive Functions:A description of a person’s

abilities to use cognitive

components for successful

goal-directed outcomes

Remediation vs. Compensation

Remediation – repair or maintain– Mental gymnastics or drills

• Brain Age – Nintendo ® Bungalow ®

• Brain-Train ® Parrot ®

• Posit Science ® Captain’s Log ®

• Luminosity ®

Compensation – substituted function– Orthotic devices or methods

Compensation Goals – Build on strengths

– Compensate for deficits

Roger Little 50 minutes

Overview of LTP

Technology for cognitive disabilities

Videos

Dr. LoPresti

– Virtual reality / behavioral cueing

Speak quick – skip devices - handouts - contact

Roger Little, MS

– Rehabilitation Engineer

– Coordinator, LTP

Ed LoPresti, PhD

– President, AT Sciences

Rehabilitation Specialist – Pre-doc Fellow

– Sara Gales

HGAC work-study student

CSEP mentorship student

Learning Technologies ProgramAbilities Enhanced Through Technology

Main emphases:

– Applied evaluations and training

• computers

• software

• adaptive devices

CSEP

– Education

– Virtual reality

– Mentorship site


Text-to-Speech

Kurzweil / Read and Write Gold

– reads electronic text, dictionary, thesaurus,

study tools, OCR

– Standardized training

– Prepare and administer tests

E-Text program

– Obtain and ready course materials


PDA’s

– Distribution and training program

– Teach use of cell phones

Internet Safety Class

– identity theft

– internet bullying

– sexual predators

– social networking


Assistive Technology Class

– basic computer skills

– assistive technologies

• Wheeled mobility

• EADL

• Vehicle adaptations

• Computer access

– MS office

– Email


• Sims: Open for Business

– virtually design and control a character matching their own personalities and tendencies.

– manage tasks such as managing a household and personal hygiene, going to work, and living within a budget

– see the results of their behaviors and the outcomes of their decisions in a safe, virtual environment

– Feedback is given to each student with regard to how it relates to them


Example: CSEP student

– KW training (2-3) sessions

– PDA training (7) sessions

– Sims training (4) sessions

– Assistive technology class (weekly)

– Internet safety (weekly)


Factors for Successful Outcomes

Client

– Always unique

– Motivation / initiation / base levels

System – not one device

Process

– Buy-in

– Follow through • Client / home / school / work / professional

– Proper set up - active participation

– Applied situation – reduce transfer of training –difficulty generalizing

Factors for Successful Outcomes

Process

– Not plug and play

– On-going process

Time

– after injury to determine needs• healing, awareness and change

– with client – getting to understand them

– client to learn and remember

– preparation

– adaptation of system and people

Design Principles (Wehmeyer 1998)

Reduce Clutter

Cluttered desktop

Cluttered desktop

Busy background desktop

Simplified Desktop


Reduce Clutter

Non text formats

• Pictures

• Graphs

• Audio

All words

Go to “Start,” then “all programs,” find

“Cannon,” click on “ScanGear starter” and

then select “ScanGear starter” from the

sub menu

Single picture


Reduce Clutter

Non text formats

• Pictures

• Graphs

• Audio

Sequential Presentation


Sequential Presenation


Picture sequence

Picture sequence


Reduce Clutter

Non text formats

• Pictures

• Graphs

• Audio

Minimize decision points

Sequential presentation

Minimizing decision points



Installing software

– Custom vs. Standard

– Auto search for drivers

Applying "Styles" and "Format painter"

Summing a column of numbers


Reduce Clutter

Non text formats

• Pictures

• Graphs

• Audio

Minimize decision points

Sequential presentation

Reduce reliance on memory

Reduce memory reliance

Copy

Close window

Save As

Open Calendar

CTRL + C

CTRL + F4

F-12

CTRL + ESC

Esc

Tab (X3)

R arrow (X6)

Enter

Common help tool

What common tool is now available for

help/guidance ???

Video

– Watch and listen

– Replay


GREAT design

ideas for ALL!

Fleming et all (2005)

•Names/eventsRetrospective

• Apts / follow-upProspective

“Poor memory”

“unreliable person”

Time Management / Organization

Low Tech

– Sticky notes

– Pre-organized books/folders

– Data planners

– Alarms / timers

Computer based reminders

Paging systems / services

PDA's

Specialized PDA's

Time Management & Organization

Invisible Clock

– 12 timers

– Vibration option

– Meeting reminder

– Count down timer

– $40

Time Management / organization

Watch Minder

– 8 daily alarms

– Vibration and beep

– Reminder mode for

common tasks

• Can assist with Training

– Not dependant on a

computer

– $90


TIMEX USB

data watch

– Enter data

using a

computer

– $90


Computer based reminders

– Outlook / Works Calendar

• Free?

– WinReminders / Notes Plus Plus / Aquarius

Soft PC Alarm Clock

• $25 - $30

– Secure Reminder

• Reminder to speech option

• $40

– Fonix voice alert

• Speaking reminder desktop/pocket PC


Paging systems - software

– SMS – short message service

– MMS – multimedia messaging service

– Computer based

– Send messages to cell phone

– Google

– www.cellphonemessagecenter.com

Paging systems – hardware

– PageMinder ®

– Issac ®

http://www.cellphonemessagecenter.com/


PageMinder

– Information alerting system

– Delivers reminders and messages to a pager or

cell phone

– Must read the text on the screen unless phone

has text-to-speech

– $25 activation and $25 per month


Isaac

– Touch screen interface

– Comes with fanny pack

– Graphical interface prompts for procedural

tasks (text, audio –

Enlish/Spanish)

– Logs data

– Administered remotely

– $2,600

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


PDA’s / cell phones advantages

– Looks “Normal”

– Basic models serve many cognitive needs

– PDA Software add-ons and Apps

• Dictionary

• Spelling / Irregular Verbs

• Word prediction

• GPS

• Cameras

• Messaging


General PDA's

– Windows

• Asus My Pal, Pharos, HP IPAQ

– MAC

• I-touch

– Palm

Smart Phones

– Windows, MAC, Blackberry, T-mobile-

MyTouch (Android), Palm Pre (Web OS) , Nokia

97 (Symbian)


Specialized PDA’s

– Voice mate ®

– PEAT ®

– Able Link ®

– Jogger ®


Voice Mate® - (No longer manufactured)

– Talking organizer

– Visual Display

– Voice Notes

– Talking Alarm

– Calculator

– Transfer to PC

– $259 - $310


Planning and Execution Assistant & Trainer

– PDA Software

– Calendar, address book, notes, cueing cards

– Pictures and sounds *

– Performance Log *

– Automatic scheduling adjustments*

• Floating tasks

• Scripting

PEAT – Advanced Planning

Floating tasks

*Floating


Floating tasks

Error


Floating tasks


Floating tasks


Floating tasks


Floating tasks


Floating tasks


Ablelink

– Visual Assistant

– Text, voice, pictures

and video

– Step-by-step

directions

– $299 software only

– PDA ~ $400


Ablelink

Pocket Endeavor

– Calendar

– Sequential task

– To-do’s

– Recorder

– Cueing

– $899 – software only

– $999 – phone software

– Phone ~$500


Jogger

– PDA with software

– Program via web

– Tracks users interaction

– Sync via telephone

– Voice; sound; lights and text

– 7 button interaction

– Windows based

Chiloh Video (10 min)

Chiloh - AT snippet.wmv

Computer / PDA hybrid

Dana AlphaSmart ®

Portable computer

– Word, excel,

Inspiration, write

outloud, CO:Writer

Palm OS

~$400

Thought Organization

Inspiration Software

– Difficulty organizing in written form

– Concept mapping

– Visual representation provides structure for

written text

– Graphics to outline

– $70

Difficult Situation example

Computer Utilization Aides

Word Prediction/Completion Software

– Suggests words based on previous word

and/or letters typed

– Abbreviation expansion

– Single entry – multiple words

– Topic specific

– Flexible spelling

– Typing/reading echo

– Reads aloud

– “Learns” words and combinations

Computer Utilization Aides – Word

Prediction Software ExamplesCO: Writer

– Flexible spelling

– Grammatically correct word prediction

– $325

WordQ2

– Simplified

– Uses word for abbreviation

– $225

SoothSayer

– Only word completion (Static list)

– Auto Complete feature

– $229


White Smoke

– Spelling / punctuation / style / grammar

– Dictionary / thesaurus

– In multiple applications (Word/Outlook etc.)

– Multi – language

– Multi-writing styles

• General / creative / technical / business

• $100 - $200

Ginger

– Spelling / grammar / TTS

Computer Utilization Aides - Reading

Software

ReadPlease

– Free version

– No study skills

– Does not work inside the

file

– $50

Confident Reader– $70 - $100

Natural Reader– $50 - $100

Kreader -$500

• Any window

• Word help

• Word prediction

R&W$ 645 – 740 (+$500)

• Simple interface

• Simple interface

• Outline tool

WYNN$475 - $1,000

• OCR editing

• Test taking

• Forms

KW 3000$1100 - $1500

Read and Write Gold

Highlights

– Any Windows application

– Talking calculator – standard / scientific

– Extensive word and language assistance

– Daisy book and PDF

– Fact Folder – save and categorizes web

searches

– Fact Finder – highlight word in document and it

will search web for info

– Help video at the bottom of each menu

WYNN

Highlights– Outline tool

– Quick switching between scanned view and text view

– Voice notes, highlights, notes in exact view

– “list” highlights, notes and bookmarks

– Simple Interface

Kurzweil

Highlights

– Scan and fill forms

– Vocabulary list

– Add notes and voice notes

– Highlight text

– “Extract” highlighted text/book marks

– Similar to other programs

– Writing helps – mind mapping

– Test Taking

Computer Utilization Aides – Reading /

Studying SoftwareAdvantages:

– OCR

– Bi-modal learning

– Slow speech down or change voices

– Does not get “tired” of repetition

Products:

– Kurzweil 3000

– WYNN Wizard

– Read and Write Gold

• Susan – video (5 min)

Susan Link - AT snippet.wmv


Voice Recognition Spelling and writing difficutlities

Dragon NaturallySpeaking

– Preferred $200 / Professional $800

SpeakQ $100 WordQ $200

– Dictate continuously

– No spelling errors

– Play back user’s voice

– Reads text on screen

– Compatible with WordQ

and Inspiration

Stephen Video (5 min)

Stephen Smith - AT snippet.wmv

Reading / Studying Devices

Franklin Language

Master

– Dictionary

– Thesaurus

– Phonetic spelling

– Speech output

– 8 line display

– $180

Reading / Studying Devices

Reading Pens

– Reads words, syllables

or definitions aloud

– Cross reference –

Dictionary or Thesaurus

– Stores and uploads to

computer

– $300

Note Taking

Teacher’s notes

Other’s write and copy

Double take note paper

Tape recorders

– Tape / Digital – upload

– Voice recognition

Video presentations

Smartboards

Smart Pen

Lifescribe Smart Pen

Writing tool (pen)

Records audio

Records video

Uploads to computer

$150 – 1 GB

$200 – 2 GB

$20 for 4 notebooks

* Note Sharing via the Web

Considerations – Training / Specs

Training– Customization

– Increased time for learning

Computer specifications– Manufacturers

• Only their software

• Bare minimum

– Constant evolution of hardware/software

– Voice input & output

– Graphics

Dr. LoPresti

Virtual Reality / Simulations

•Benefits

•Explore situations from a safe environment

•Experiment with different approaches to a

situation

•Explore differing viewpoints

•Immersive v. non-immersive virtual reality

The Sims

• Video game that simulates everyday life

• Characters maintain a household, hold

jobs, manage social relations

• Based on Maslow’s hierarchy of needs,

characters have basic needs and higher

aspirations

Clinical Application

Used in CSEP program

Clients create a character based on their

own personality

Clients play the game, trying to meet the

character’s needs, job requirements, and

budget

Goals

• Self-awareness

• Planning and problem solving

• Vocational awareness

• Social awareness

Self Awareness

• See how selected personality traits effect

the character’s behavior

• Real-life issues reflected in the game due

to the character’s personality or the

client’s playing style

• Exploring strategies• Trying to maintain a schedule

• Experimenting with less rigid behavior

Character Creation

Planning and Problem Solving

basic needs

wants and fears

budget

Vocational Awareness

getting to work

effect of physical, emotional state

job skills

Social Awareness

• Exploring ways to meet character’s need

for socializing

• Exploring characters’ reactions to the

same situation

Second Life

Online Community

– Potential for role-playing social situations

– Potential for practicing social techniques with strangers in a relatively safe environment

– Existing social/support groups

Simulation Drawbacks

- Immersion in virtual environments could limit

participation in real-life relationships

- A therapist’s active role is crucial to facilitate

transference of lessons learned in the game to

application in real life

-Simulation is a only caricature of real life

Discussion

Resources

Book:

Cook, A. M., & Polgar, J. M. (2008). Cook and Hussey' assistive

technologies: Principles and practice (3rd Ed.). St. Louis: Mosby

Elsevier. ISBN: 978-0-323-03907-9

Articles LoPresti, E.F., Mihailidis, A., Kirsch N. (2004). Technology for Cognitive

Rehabilitation and Compensation: State of the Art. Neuropsychological

Rehabilitation. 14(1/2):5–39.

LoPresti EF, Bodine C, Lewis C. (2008). Assistive Technology fo

Cognition. IEEE EMBS Magazine. 27(2):29-39.

Journal - Cyberpsychology and Behavior www.liebertpub.com/cpb

http://www.liebertpub.com/cpb

Resources on the Web

Brain Injury Association of America

(http://www.biausa.org/)

Brain Injury Association of America Assistive

Technologies and Cognitive Disabilities Project

(http://www.biausa.org/at.htm)

Coleman Institute of Cognitive Disabilities

(http://www.colemaninstitute.org/)

Consortium for Handheld Technology

(http://www.vcu.edu/partnership/pda/)

http://www.biausa.org/

http://www.colemaninstitute.org/

http://www.vcu.edu/partnership/pda/

Resources on the Web

Rehabilitation Engineering Research

Center for the Advancement of Cognitive

Technologies (RERC-ACT)

– www.rerc-act.org

Rehabilitation Engineering Research

Center on Wireless Technologies

www.wirelessrerc.org

http://www.rerc-act.org/

http://www.wirelessrerc.org/

Documents

Assistive Technology Cognitive Disabilities...Take-aways from today: Focus is NOT on technology –AT should always support functional activities Both cognitive status (patient) and