Ed Hitchcock OT/L ◦ Full time Assistive tech since 1999

◦ Wide variety of Rehab clients

◦ By no means a cognition guru!

And who are you?

Lecture will largely be focused on compensation for cognitive deficits ◦ Remediation vs Compensation

Psychological sequelae

Apps- 2.5 million as of 7/14

Funding

Remediation ◦ Physical deficits

Restoration appropriate

But ◦ Computer as a previous (or to be developed) role

◦ Allow for participation in usual way or alternative way

◦ Functional!!

Cause effect through high level cog deficits

Communication ◦ Email, SMS

◦ Social networking

Documents

Journals ◦ PTSD, memory

Organization

Physical deficits ◦ Has a profound influence on use of tech

◦ Alternative mouse

Eye, Head, Upper Extremity

◦ Alternative Keyboards

Large, Small, Onscreen

Word Prediction, Abbreviation expansion

Visual Compensation Isolated text to speech

Screen reader

Technology experience

Technology tolerance

Preferences ◦ How “cool” is the device?

◦ Normalization of device/technology

Higher level switch access ◦ Computer (various programs), IOS

◦ Tecla Android

◦ Requires a switch interface or touchscreen hits

◦ Switch cause/effect is limited (on MC)

Computers ◦ “Mature technology”

◦ Relatively stationary

Tablet/Smartphone (MC) ◦ Technology developing at a rapid clip

◦ Relatively portable

◦ Not as many access options

Computer ◦ Dragon, Microsoft SR

◦ Can be completely hands free

◦ Relatively high visual, cognitive and literacy demands

◦ SpeakQ

Relatively high physical demands

Relatively low cognitive and language demands

◦ Consider different sizes

Phone Or “Phablets”

Tablet: 7”, 10”, 15”, 24”

◦ Consider networked or non networked

Most tablets

Old phones easily available that can connect via wifi.

More limited than computer

Siri, Google Now, Dragon Mobile ◦ Button activation is preferable

Either on tablet/phone

or external switch

Isolated behaviors ◦ Send text

◦ Calendar appt

◦ Set alarm

9/2/11

2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation

Android SR Dragon on PC

Consider use as a compensation for multiple minimal deficits ◦ Hemiparesis

◦ Minimal literacy issues but fluent speech

◦ Reduction of multiple steps involved in programming calendar appt etc.

Does require some degree of frustration tolerance and “dictation skill”

AAA Study

Enlargement of font/zoom Text to speech ◦ Reading isolated text ◦ Speak selection iOS, or Easy text to speech

(Android) ◦ Various apps on tablets ◦ SMS in “driving mode”

Screen reading ◦ More for complete or severe VI; increased

complexity

Organization ◦ Placing items to one side, removing unwanted items

Tablet ◦ Icons/Presentation of information

◦ IOS-removal and customization through folders

◦ Android- many more options

Complete removal

Resizing

Use of Widgets

Interface

simplification

Use of calendars ◦ Caregiver programming info on computer; sync to

client phone

◦ Use of calendar to send email/text as an “Alert”

If client insight is limited, this may be best/only option

Calendar online

Put in time, date description etc

Notification styles

Consider Alert style ◦ Beeping?

◦ Vocal alerts?

◦ Auditory feedback “Ed, Look at your phone”

◦ Text to speech options via SMS

Android ◦ Ringtone maker

◦ Record a prompt

◦ Use Ringtone maker to set it as a notification

IOS ◦ Ringtone maker through ITunes

Set android device to read out incoming SMS automatically ◦ Some native options

◦ Easy text to speech app

Google calendar set up notifications via SMS

More robust notification options ◦ MegaSound Android

“Find my children”

Various security phone options ◦ Lookout

◦ Cerberus

◦ Android Device manager

◦ Wheres my iPad

To do list ◦ Reminders

◦ Wunderlist

◦ AnyDo

◦ It’s Done!

Developed for repetitive and routine tasks

Repetitive reminders ◦ Due IOS

◦ Repeating notifications Android

Reminder app; iPhone

only (not iPad)

Google Now

Google Keep

Medication reminders ◦ Pillboxie (IOS)

◦ Medsy (IOS)

Istudiezpro; InClass(IOS), Studious (Android)

Notability (IOS) AudioNote (Android) ◦ Note taking/recording

Text notes

Audio

Pictures

Handwritten

Cloud backup ◦ Access from multiple devices

◦ Note History

Diaro

MyDiary

Galaxy Gear, LG G, Motorola

Pebble

MetaWatch

Journaling of symptoms/Stress mngt ◦ Breathe2Relax

◦ PTSD Coach

◦ Mood tracker

◦ Android and IOS

Consider series of auditory cues ◦ Can also consider use of video reminders

Smartphone/Tablet ◦ Use of “Tasker” (android) to play audio or video

reminders at a certain time

Conover videos ◦ Hygiene,

dressing, ADL

◦ Video of each step

IOS

To do list

Allows for photo cues of subroutines

Alarm which leads into routines

Executive function schedule assist ◦ Schedule

◦ Flexible schedule

◦ Cue cards

Published evidence does not indicate computer programs to remediate cognition ◦ Minimal generalization (Rabipour, S., Raz, A., 2012)

◦ Recommend clinician guidance

◦ Recommended against use (Cicerone, 2011. MacDonald, S., & Wiseman-Hakes, C., 2010)

◦ Requires relatively strong exec attention (most often impaired)

Adjunct to clinician guidance

Functional goals are important

Relatively intact executive function

Perhaps Long term exposure will assist?? (Rabipour, S., Raz, A., 2012)

Intensive exposure?

Lumosity Mobile

Visual Attention TherAppy

Count25 ◦ Attention, perception, memory, and processing

speed

Schulte Grid ◦ Trains attention

Brain Challenge HD ◦ Train: Visual, Memory, Logic, Math, and Focus

CogniFit ◦ Memory, focus, attention

◦ Play against yourself or others

Clockwork Brain ◦ Tests various cognitive abilities such as: visual,

spatial, logic, language, and memory

Brain Reactor ◦ Challenges attention, processing speed, general

knowledge, and math

Aces Traffic ◦ Strategic movements to remove barriers to free cars

iMazing ◦ Planning, attention to detail, visual attention

Skill Game ◦ Requires planning, organization, attention to detail

Retired Police officer

Physically and visually intact

Decreased STM-Unable to ID deficits ◦ Unable to remind therapist of functional need post

5 min.

DR setting with support from the SLP

Programmed phone for calendar appt with auditory alert

Very focused on phone

Responded appropriately to multiple appts set through remainder of day

Oriented to task and calendar apps.

Not interested in Journaling apps

Required additional cues to respond to aud cues

Able to program cues/appts with max cues.

Required cues in subsequent sessions to respond to cues.

Cues to dismiss tasks upon completion- did perform one task 2x.

Able to set up task with mod cues faded to none for second trial

Responded appropriately to 4/5 tasks programmed

Good support and follow through from SLP

Requesting different color codes for appt- Business calendar Pro

Continues to refuse journaling app

Ultimately dependent on CG to program appts for him; but responding appropriately to his cues

TBI following a fall

Options for organization

Documentation for school

Evernote ◦ Audio notes and memos

◦ No HW option on IOS in Evernote

Meds ◦ Trial with Med coach- Unsuccessful

◦ Easy to set up but did not want

Its Done ◦ Remind on meds

◦ House hold tasks

◦ Use to inform mother

IOS for monthly repeat app (Med refill)

Location based reminder

Did not want repetitive reminder apps

Previously using DD app to take notes ◦ Multiple steps involved in transferring to notes app

◦ Oriented to use of Siri from Keyboard.

General transition to use of Siri from keyboard into relevant app, vs 1 step use of Siri

Calendar ◦ Siri to set appts

◦ Sync G Calendar; mother and boyfriend to access

◦ Location services for use with navigation

Speech rec options- DNS Trial

Class mngt ◦ iStudiezpro review

◦ Livescribe (trial Notability)

Ed Hitchcock OT/L

ehitchcock@ric.org