Break the Barriers!Using AT to Increase Independence for persons with brain injury or cognitive disabilities

Elaine Phillips, MSP, CCC/SLPOutpatient Brain Injury ProgramRoger C. Peace Rehabilitation HospitalGreenville Hospital System University Medical Center

What is cognition? The act of knowing or thinking

Cognition involves attention, concentration, memory, information processing speed, awareness, judgment, planning, decision-making, language, visual-spatial skills and reasoning

Memory Impairment

One of the most common and disabling effects of a brain injury

Why is it so disabling? Lack of recall creates anxiety Not remembering makes you unsafe Poor retention makes it difficult to learn

anything new Performance suffers at school and on the job Not remembering makes you dependent on

other people

Memory

Having a way to remember lets a person be more independent and safe.

Prospective Memory

Timely remembering of a planned action Remembering to remember

Why Use AT?People with Cognitive Disabilities Increases independence and self-sufficiency Reduces the need for costly on-going caregiver services and promotes less

restrictions on living environments Allows for the most natural possible employment Reduces the need for direct personal intervention by professionals or family

members Increases productivity Family Members Increases freedom Allows more time for other needs

What are the person’s strengths and limitations?

Know thy client/patient/family member! Severity of the memory impairment Types of memory and their relative strengths or

weaknesses Awareness of memory deficit Attention skills Problem-solving skills

Assess need for assistive technology Low tech vs. high tech Complexity of AT vs. client’s strengths and

weaknesses Cost vs. effectiveness Clearly define how AT would help

Low Tech Memory Strategies Chunking Categorization Rehearsal Association Mnemonics Visualization Write it down!

Write it down! Calendars Logs/journals

Daytimers Checklists

Meet Jimmy… HS graduate Good work history in

production Recently had new baby

with live-in girlfriend Very supportive brother Jimmy wants to work.

S/O wants him to work. Everybody wants him to work.

Jimmy’s whats Aphasia- understanding

complex directions and expressing himself is difficult

Reading and writing are now very limited

Moderate memory deficit Moderate deficits in

awareness Poor frustration tolerance Fine motor skills & speed

impacted Continued cognitive & BP

issues make return to any type of competitive production work challenging

Jimmy’s goal: Go back to some type of work

How will he learn any new task?

What can he do? How can he be

consistent?

Learning a new routine Picture-based check-off list Environmental modifications Supervisor check-in Multiple repetitions Structured routine Procedure for non-daily events

High Tech Memory Aids

Generally require set-up by another user/professional

Current devices on the market mainly perform dual functions

Timex IRONMAN Triathlon Data Link® watch “The sportswatch that thinks

it’s a PDA!”

$90.00

www.timex.com

Men’s only

Comes with USB cable and Datalink software

PageMinder 1-time $25 activation fee + ongoing

$20/month + monthly pager or cell phone fees

Get Reminders For: Medications times and doses Medical appointments Recurring events or meetings Daily living skills Any routine task www.pageminderinc.com

The Jogger™ uses a combination of handheld PDA

and Internet technologies prompts an end-user to complete

impending tasks such as job functions, chores, taking medications and transportation instructions

records the end-user's response to each task prompt and transmits the responses to the caregiver for analysis

and follow up modification. www.thejogger.com

SmartShopper Voice-Activated Grocery List $149.95 www.sharperimage.com Portable handheld device that

records, categorizes and prints a list of errands and shopping items.

Database holds 2,500 types of errands and marketplace items.

Magnetized to stick on your fridge.

More high-tech options… Cell phones GPS Blackberry IPhone Other PDAs

Training use of ANY memory system Necessary

Generalization doesn’t occur without a plan Systematic

Start with the whole onion Peel off the layers

Structured Routines create predictability Decreased frustration

Let me introduce you to Brian… 30-something engineer involved in MVC last

year out of state Now lives with elderly mother Severe deficits in initiation and moderate

verbal memory impairment Cannot complete morning routine (including

meals) without multiple prompts

What do you already know? Family dynamic He’s a gadget guy…

Recommendation: PageMinder Began by faxing in prompts during treatment

day Not without its problems… Able to use successfully in clinic Family unwilling to begin use at home; felt

team was “overly critical” Continues with use of verbal prompts

In the Literature…

A Comparison of Four Prompt Modes for Route Finding for Community Travellers With Severe Cognitive ImpairmentsBy Sohlberg, et al Brain Injury, Vol. 21, No. 5, pp. 531-538, 2007

A Mobile Phone as a Memory Aid for Individuals With Traumatic Brain Injury: A Preliminary Investigation By Stapleton, Sally et al Brain Injury, Vol. 21, No. 4, pp. 401-411 April 2007

A Randomized Control Trial to Evaluate a Paging System for People with Traumatic Brain Injury by Wilson, Barbara, et al, Brain Injury, Vol 19, No. 11, pp.891-894

Portable Electronic Devices as memory and organizational aids after traumatic brain injury: A consumer survey study”, Hart, Buchofer & Vaccaro, Journal of Head Trauma Rehabilitation, 2004