02/10/2012

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Dr Clare Ramsden

Consultant in Neuropsychology & Rehabilitation

Brain Injury Rehabilitation Trust

Thinking Outside the Box:

Using off-the-shelf technology

in neurorehabilitation

Aims To provide you with an appreciation of the range of

technology now available to clients for rehab

To consider the impact of a client’s cognitive impairments and the benefits of assistive technology for cognition (ATC)

To consider the impact of a client’s cognitive impairments and the barriers to using assistive technology for cognition (ATC)

ATC in Rehab “very little is known about the relationship

between, on the one hand, the clinical characteristics of persons with cognitive impairments, and on the other hand, the specific characteristics of ATC (Assistive Technology for Cognition) interventions that are most suitable for those individuals” (LoPresti et al., 2004, p 25)

Role of Technology Assistive technology for cognition as

extension of existing rehabilitation principles:

Compensatory: e.g., memory aids, reminders, pillbox devices, cues & prompts

Risk Management: journey trackers, pillbox devices, sensors

Retraining: cognitive ‘retraining’ apps

ATC prescription Gillespie, Best & O’Neil (2011) suggest using

ICF framework, and categorising AT devices in terms of function (e.g., alerting, distracting, prompting, navigating, reminding, storing, displaying). Can then build up a template where you can input a client’s ICF impairments and have this matched with a relevant AT device.

Number of studies in each ISO category published per year

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ATC: purpose built or off-the-shelf? Neuropage, Sensecam (Vicon Revue),

AbleLink

Smart phones , tablets, netbooks/notebooks, cameras, voice recorders, e-readers, speakers, pagers, mobile connectivity, apps.

Sensecam Sold as Vicon Revue in UK.

Takes photos automatically either triggered by internal sensor, or on timer (30 sec).

Review images at end of day or event.

Can use for memory rehab (esp. autobiographical), support with CBT after ABI, lifelogs/visual diary, cueing & recognition memory, monitoring (e.g., eating, meds, etc).

Around £300 (ex VAT)

Sensecam AbleLink Range of software options that sit on a smartphone

(e.g., HTC).

Simplified desktop software that sits on top of the existing operating system (Endeavour Desktop)

Simplified mobile phone device (Pocket Ace)

AbleLink Visual Assistant Task prompting

programme, with customised audio & visual display (can be pictures or video footage). Fairly easy to set up, very easy to use

AbleLink Pocket Endeavour “…an integrated, discreet,

and portable solution for managing time, sequential and non-sequential tasks, lists, notes, instructions, classroom lectures, and more”

Memory & Executive Function

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Able Link Portable Tablet PC Picture and vocal memory

aid

One-off and recurring appointments can be recorded

Tasks such as how to put on the dishwasher or make a sandwich can be broken down to easy step stages with vocal and picture prompts

AbleLink WayFinder GPS-based personalized

audio and visual cues to support independent travel via bus systems and on foot. Can create specific travel routes, activated from the GPS location. Users receive customized audio and visual instructions to prompt them through route navigation.

Pagers & alerting systems Neuropage – well known & documented

Findings may be generalised to other alerting & messaging programmes, e.g., on a smartphone.

Context-free cuing (text of ‘stop’) – cue to reflect on internal goal states, resulted in better performance on scheduled tasks (Fish et al., 2007)

Neuropage costs £89 deposit + £60 per month

Smartphones & iPads/Tablets Socially acceptable

Increasing pre-injury familiarity

Some degree of intuitive interface, even for ABI.

Touchscreens can be easier for some with physical impairments

Introduction of apps specifically focused on cognitive/language impairments & needs (e.g., Its Done!, Proloquo2go, etc).

iPad 3 - £399; iPod touch - £170; Samsung Galaxy ~£200

Mobile ATC? Can I use a smartphone, iPad or tablet as a useful,

meaningful ATC device?

What apps are out there that are useful in rehab?

What apps are beneficial to those with cognitive impairments?

Are there apps specifically for people with cognitive impairments?

Memory Task managers/schedulers: AA Task, DoIt

(tomorrow), ToDo

Memoires: The diary; Day One – Journal: Journal/ lifebooks combining a number of smartphone functions such as text, images, video, GPS links, etc.

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DoIt (Tomorrow) Tasks n Todos

Memoires: The Diary Day One - Journal

Benefit of text plus video/image record. However, typing on smartphone screen can be frustrating!

Medication reminders Visual Pill Reminders (Android)

Pillboxie (Apple)

Pillboxie

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Visual Pill Reminders Daily Planning & Organising Google calendar

Pocket Informant (Apple) – more like a diary, can schedule tasks & events, colour-code, organise.

Corkulous (Apple): visual virtual corkboard. Can add notes, labels, photos, contacts & tasks. Pinterest (web-based)

Wallet Advanced (Apple): for managing passwords, pins, numbers, etc.

AA Task: Schedule & memo App (Android)

Pocket Informant AA Task

CalenGoo Its Done! App devised

specifically for ABI or memory impairment/executive dysfunction.

Schedules, reminds, & ticks off and sends completion notices (email or SMS)

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Corkulous Pinterest

Communication Proloquo2go ($190 USD, Apple): Assistive

communication device for those with problems speaking.

Answers: YesNo (Apple): Choice of 2 answers. Comes with Yes/No, also customisable.

iCommunicate for iPad: story boards, flash cards, choice boards, etc.

Dragon Dictation (Apple): Voice recognition software that translates into text.

iBooks with Voiceover: Apple eReader

Proloquo2go

Proloquo2go Answers: YesNo

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iCommunicate for iPad Community Access & Safety Navigation: Google Maps & Navigation. Using

Google Street View as quasi-virtual reality for off-escort training.

Location: GPS tracker, Life360, SafeJourney, Google

Life360 Find family & friends

with GPS

Check in function

‘Safe place’ ID – police stations, hospitals.

Finances & Shopping Expense Manager, Money Manager (Android); Piggie

(Apple)

Lemon Receipts (Apple or Android): photo paper receipts, email electronic receipts – collated into useful info.

Easy Shopping Calculator (Android): simple shopping calculator

Food Planner (Android): meal planning, shopping, recipes, stock management, etc.

Snap n Draw (Apple): Visual shopping list

The Valuator (Apple): Calculates best value between offers

Snap n Draw Lemon Receipts

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Emotional management T2 Mood Tracker: Mood rating & monitoring on

6 pre-set scales, also customisable scales.

T2 Mood Tracker

Stress Management Breathe to Relax, Tactical Breather (Apple):

cued breathing exercises to manage stress.

Stress Tracker: Records and tracks stress levels, moods, sources of stress, symptoms, and behaviours.

Biofeedback devices – heart rate monitors that can both cue to elevated heart rate and record heart rate over periods of time for review.

What next? Visual recognition systems (e.g., Google Goggles)

Voice to text to voice systems (Siri, Dragon)

Biofeedback linked devices

Tech downsides Complex – devices such as Ablelink’s Discovery

Desktop can help with this (overlay simple presentation on top of PC/PDA screen). Often requires language skills & manual dexterity

Can be visually complex – small devices can be problematic to see, larger devices to carry around

Requires person to do something – to follow the prompt, to recognise the cue, etc.

May require some new learning

Tech upsides Can increase independence in some areas,

allowing staff time to be spent elsewhere

Can encourage positive feelings of control, engagement in normal life activities, age-appropriate behaviour

Increasingly, people are coming to rehab with tech knowledge & understanding.

Tech partners, like communication partners

Reduce reliance on others, or need for prompts

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Off the shelf? Increasing number of devices & apps that appear

to be useful for the rehab population.

Need to be carefully tailored to the individual

Person may need a simplified version. Now some simplified devices that look similar to standard devices – person feels engaged with them, but they are appropriate to needs.

Off the shelf can be cheaper than specialised devices

Literature Current literature supports use of ATC in

rehabilitation

Don’t need to do research on every device, but rather on the mechanism the device uses (e.g., prompting devices can look to the neuropage literature).

Gillespie, Best & O’Neill (2011): ATC prescription & classify ATC based on cognitive function.

Useful resources Gillespie, A., Best, C., & O’Neill, B. (2011). Cognitive

Function and Assistive Technology for Cognition: A Systematic Review.

Technology for Psychologists blog: http://sylvainroy.blogspot.com/