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Tools You Can Use 2014

Jen Mundl, MS, ATP Assistive Technology Specialist

Courage Kenny Rehabilitation Institute jenim@courage.org

763-520-0567

Presentation Agenda

• Considerations

• Low-Tech Solutions

• Writing/Note-taking

• Computer

Opportunities

• Use of Portable Technology

• Academics

• Test Taking

• Common Assistive Technology

• Cognitive Assistive Technology

• Mathematical

Solutions

• Shareware and

Freeware

• Resources

• Contacts

Talking about Assistive Technology

• We all use assistive technology whether or not

we identify an item to be adaptive. It is a

device or tool which makes it easier to accomplish a task.

• You do not need to have a disability to benefit from assistive technology.

• Even though it is called assistive technology, technology does not necessarily end up being

the solution. What to Consider

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Common memory problems after TBI

• Short term and recent memory

• Names and faces

• Details and sequences during the day

• Information that someone told you

• Declarative memory

• Knowledge base (storage of events, facts, words)

• Prospective memory

• Remembering to complete a task in the near future

• Future appointments

Assistive Technology Continuum

No tech to Low-Tech

to High Tech

No Tech

Low-tech

High-tech

A Person with A Brain Injury

• KISS – Keep It Simple Silly

• Consider Low-Tech or Built-In Accommodations

• Create A Memory Book

• Identify Physical, Cognitive, Visual, and Psychosocial Needs

• Do Not Buy On Impulse or Advertisement – Do Your Research!

Simple Solutions

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Simple Solutions

• “Home-made” aids are simple solutions for many types of cognitive problems. A large print calendar is an important tool to note daily routines, appointments,

special occasions, and future events. For some individuals, reading a clock with hands may be difficult. An alternative choice may be a digital clock displayed in

clear view. A Talking Clock and Talking Calendar will announce the time of day and date aloud with the push of a button, and can be accessed as many times as the

individual needs the information. For those needing reminders across environments, talking watches with date and time features are also available.

Attention, Concentration, and Organization Difficulties

• Maintaining a predictable routine and structured environment

• Complete one Task before moving to the next task Minimize background distractions

• Frequent breaks

• Utilize a step to step outline for note taking

• The person may benefit from alternating tasks of high and low interest. If arousal is an issue, less interesting tasks should be completed at the time of highest arousal.

• Make sure the individual with a TBI has your undivided attention and repeat information

• Ensure adequate sleeping patterns

• Take advantage of interest and best time of day

• Develop a behavioral plan with positive reinforcements

The Art of Remembering Items

Keep things in the same place at all times, such as keys hanging on a hook by the door, an address book and stamps in a drawer by the phone, scissors in a sewing box, etc.

Establish a spot or box near the door to place objects you need to take with you, such as memory books, keys, wallets, packages, umbrellas, etc.

• Create a list of items needed on all outings

Learning New Information

Mnemonics may be used to help you with

recalling lists.

Never Eat Sour Watermelons

HOMES to remember the Great Lakes

To remember where your car is parked, look for permanent visual cues and describe them out

loud.

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Routine Is Your Friend

• Do activities on the same day each week or

month. For example, pay bills on the last day of

the month, go to the bank every Wednesday, to go the grocery store every Tuesday, go to

therapy on the same days each week, etc.

• Use direct deposit and direct bill paying

services, available through your bank, to ensure

that your checks are deposited and that

important bills are paid on time.

Telephone Use

• Keep a notebook by your phone and keep a log of who called, what time, and what each person wanted. Also keep track of calls you made, who you called and what

time.

• You can also keep this log in your memory notebook

• When you take a phone message, write down the most important information.

• First: write down the caller’s name and phone number.

• Second write down the date and the time.

• Third, write down the content of the message.

• Consider utilizing a recorder which attaches to a

telephone

Recalling Names

When meeting someone new, repeat the

person’s name as soon as it’s said.

Ask the person to spell his or her first or last

name, even if it’s easy to spell.

When you leave a situation when you’ve just

met someone, end the conversation by saying

the person’s name

Initiation Problems

• Provision of environmental cues may be helpful

in prompting the individual to complete tasks.

• Linking behaviors that “naturally” go together

may increase the likelihood of the target

behavior

• For individuals whose lack of initiation is due to

depression, initiation of antidepressant medications (e.g., SSRI) may be indicated. If this

is suspected, consultation with a physician is

needed.

• Family or support group for TBI may help learn

new techniques

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Language

• Carry an emergency contact info

• Create a laminated communication board

• Important people (e.g., family members, friends)

• Commonly encountered items (e.g., foods, medications)

• Regular activities (e.g., going for walks, knitting)

• Facial expression of different moods (e.g., happy, sad, angry)

• Frequently visited locations (e.g., grocery store, friend’s home)

• Utilize multiple choice questions to facilitate communication

• The individual and those with whom he/she interacts are encouraged to remain patient when communicating.

• He/she can benefit from gentle cuing and in addition to writing responses as he/she is able.

• Speak clearly and slowly

Memory Issues

• ·Persons with TBI can benefit from using a memory/organizational notebook to keep important information, including calendars, phone directories, and to-do lists.

• Many cell phones have note taking options in them

• A short message recorder

• For individuals who may have a tendency to lose important items, it can be helpful to set up a central location (e.g., a large bowl

placed on an entryway table) where these items (e.g., keys, wallet) are always placed.

• Timers can be useful in providing cues regarding when it is time to take medications, check blood sugar/blood pressure, etc.

• Repetition (e.g., reciting the information to be remembered several times) is often helpful.

• Labeling doors, drawers, cabinets, and dressers may be helpful in cuing the person about where to find items.

Slow Processing Speed

• The individual with TBI, and those with whom

he/she interacts, should plan to allow additional

time for the completion of projects. This will minimize frustration or errors that can result from

experiencing time pressures.

• Cognitive efficiency may be compromised

when information is presented too quickly or

when too much material is presented at once.

Therefore, information can be presented in

smaller chunks, giving the person with TBI opportunities to repeat it to ensure it is

understood and to promote memory for the

information.

Termination Problems

• Respond directly to inappropriate statements or behaviors

• Cue and redirect the person from

focusing on inappropriate topics, objects, etc.

• As with disorders of initiation, individual and/or familial counseling may be helpful in developing realistic

expectations, coping with stressors, and problem solving difficult situations.

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Visual-Spatial/Disorientation Difficulties

• Eye exam and corrective/magnification lenses

• Utilize colors to highlight materials with highlighters or tape

• Reducing Clutter

• Lighting adjustments

• If visual signs are in use in the person’s environment (e.g., as reminder cues), use of single words may be best to minimize visual demands.

• Retraining person to look around and not in one place

• Use all six senses

• If left-right confusion is a problem, the person can wear a bracelet to assist in determining this orientation (e.g., a bracelet that says

“LEFT” to be worn on the left wrist).

• GPS

Memory Journal

Memory Notebook System

• Improves orientation

• Helps with recall of past, present and future

information

• Improves planning of tasks

• Can be tailored to the individual

• Training in how to use and development of meaningful information

Memory Book Important Items

• Difficulty recalling:

• Names

• Items

• Events

• Personal information

• Phone calls

• Conversations

• Utilize colors, actual pictures, concrete

information, short bulleted notes, and large print

• Individual will require training to learn how to depend on the memory book and to ensure it

is always available

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Items In a Memory Book

• Make it personal with pictures and a meaningful cover

• Bulleted simple instructions

• Colorful calendar with different colors for different categories

• Important Information in note format

• Large Print

• To Do List With Dates

• Contact Information

• Medical Essential Data

• Pockets and Paperclips

• Business Card Holder

• Three Ring Binder

• Information in case it is Lost

Tips for using a daily memory notebook system

• Put the book in a high traffic area so you’ll be more likely to use it or look at it.

• Check the book frequently—plan on looking at the book at least 3 times per day.

• Family members can help with cues and reminders.

• Set an alarm (watch, cell phone, kitchen timer) as a reminder to check notebook.

Assistive Technology

Tools

Electronic aids

• These devices often have calendars, to-do lists

and note features.

Galaxy iPod touch PDA

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Step Pad

• The StepPad is a powerful yet easy-to-use cognitive support tool for people who have trouble

completing multi-step tasks independently. Directions that you record are played back in

sequence, one step at a time, to prompt the user on what to do next. The StepPad functions well

as both a short-term teaching tool and a long-term adaptive aid.

Go Talk

GoTalk 9+ is lightweight and

rugged, like all of our GoTalks,

and has a 45 message capacity

and five recording levels. PLUS

three “core messages” which

stay the same on each level so

you don’t need to re-record

essential messages for each

level.

Talking Photo Album

The Talking Photo Album

includes a total of 24 pages,

each with a individual message

capacity of 10 seconds. Insert

photos or picture/text cards into

the transparent sleeves and

record corresponding

messages. User squeezes the

play button to activate speech.

Time Pad

Record a message, then set the clock to play it

back at just the right time. Remind users that

“gym class begins in five minutes,” or “it’s 3 o’clock, time to go.” You can also add a

picture cue for additional information.

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VoiceCue

• A clever, discrete auditory cueing device

• Record up to five messages (60 seconds

total recording time) and set the clock to play back messages at pre-set times.

• Each message can be assigned two

playback times. For example, record “Time to take your medication” and set the clock to play the message at 7 a.m. and again

at 6 p.m. If the message catches you off guard and you’re not sure what it said, just press the replay button within one minute

to repeat the last message. Change messages or play time anytime you want.

Big Button

• Two styles of Big Buttons are

powerful communicators with

easy-touch activation

• A transparent cap, with an

opening to quickly slide in overlays, snaps onto the Big

Button. The cap extends nearly

to the table surface, giving the

Big Button a large active area

with an extremely low profile. You can actually communicate

without lifting your hand off the

table!

Clip Talker

• The Clip Talker has a single

message with eight seconds of

quality recording time. It features an easy-to-press play button, a

convenient play/record switch and

an LED that lights up when you

record. Its palm-size makes it an

ideal handheld communication device.

Live Scribe 4 GB Smart Pen

• Live Scribe digital pen is a device

in which you can write a couple

words and attach an audio recording to it. It works with many

programs including Evernote,

Word, and the Internet. It

provides a voice output for

individuals who find it difficult to write things that are able to say

what they want

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Specialized Devices

• The Jogger

• www.thejogger.com

• Pocket Endeavor

• PEAT

• www.brainaid.com

Medical Needs

Medication Reminder

• Another Alarm to Combine with Possible Watch

Alarm

• Medications May Be set up by A Family

Member or other Response Individual

• Training Is Necessary

• Maxiaids.com provides a large selection of

options

Calendar Apps

• 365 Days

• Priority Matrix

• All-Purpose Calendar App

• Calendar Reminder

• Google Calendar

• Quick Calendar

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Check Lists

• A checklist may be used to help remind a

person to complete certain tasks. For example,

a daily checklist placed inside the door to a home may include reminders like, “take house

key”, “turn off iron” and “lock front door”.

Home-made labels can also help people

remember the contents of a drawer or closet

and can be made using words or pictures.

Behavioral No Tech Methods

Guidelines

• People with brain injury often have difficulty in

understanding how their behavior affects

others. When this is the case, the environmental conditions surrounding people with traumatic

brain injury (TBI) can have a significant impact

on behavior, without the person with a brain

injury fully appreciating that fact. Organize the

setting and plan the approach to the person, to increase opportunities for successful learning

and decrease behavioral problems.

Time for Rest

• Allow time for rest – people with TBI can be

extremely fatigued, which can be a strong

antecedent to a behavioral episode. However, do not let fatigue be used as an escape from

compliance.

• Watch with repeating

alarms(Watchminder.com)

• Computer or iPad Apps for Repeating Break

Time (Stopwatch Professional)

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Simple environment

Keep the environment simple – people with TBI

are easily over-stimulated so distractions should

be kept to a minimum.

• Organized and Clean

• Keep It the Same

• Placement of Items in One Location

• Declutter

• Simplify

Instructions

Keep instructions simple – directions should be as

concrete as possible. Use non-verbal cues, such

as gesturing if the person has difficulty processing auditory information.

• Utilize preferred learning style– http://www.learning-styles-

online.com/inventory/

Auditory

Visual

Kinesthetic

Tips to Implement

• Give feedback and set goals – self-monitoring skills can be diminished following brain injury, so provide frequent feedback and set goals to help the person understand

how and why they are doing a task.

• Be calm and redirect – remaining calm can help reduce

agitation by demonstrating control, creating a nonthreatening environment and not inadvertently reinforcing a problem behavior.

• Provide choices – this can help the person feel an element of freedom and control over his or her environment. However, use “limited” choices so there is

no opportunity to say “no” or for the person to feel overwhelmed.

Working Style To Promote Success

• Decrease chances of failure – try to keep the

success rate above 80%. This ensures the person

feels both successful and challenged.

• Vary activities – alternate activities to maintain

interest. Interspersing easy tasks with more difficult ones is also helpful.

• Over plan – be prepared with enough activities so that you can adjust tasks to suit daily

fluctuations in the person’s functioning.

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The Task at Hand

• Task – try dividing tasks

into smaller parts, each

of which can be

treated as a complete task. Activities are

easier to accomplish

one step at a time.

Memory Aids

Voice Recorder

• Small voice recorders on keychains or message

recorders can be pre-recorded with reminder

messages including appointments, telephone numbers, grocery lists, or prescription refills.

• Voice Cue

• Watch Minder®

• Olympus VN – 4200

Watch Minder

• Gives the user both audible and text

reminders

• important information can be stored

in its Apps

• connects to a computer to

download calendar of events

• can store multiple schedules for the

week

• contact information

• reminders to pay attention

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Reminder Wristwatch

• Reminder Watches

Timex USB Data Link Watchminder Wrist PDA Databank Fossil Data Link

Daily Living

Medication Alarm

• The Pill Alert provides an alarm feature that can

be set to ring at the time or times medication

needs to be taken. Some reminders automatically reset to repeat at the same

countdown interval, or have lights that identify

the compartment that should be opened.

Medication alert devices may be pocket-sized

or housed in a wristwatch. Try maxiaids.com

Games for the Brain

• http://www.easterseals.com/our-programs/brain-health/?gclid=CPOl1vrbur0CFSISMwodzyUAwg

• AARP

• Play With Your Mind – http://playwithyourmind.com

• Brain Arena – http://www.brainarena.com

• MyBrainGames http://www.multiplesclerosis.com/us/index.php

• PositScience – http://www.positscience.com

• Happy Neuron, Inc. – http://happy-neuron.com

• My Brain Trainer – http://www.mybraintrainer.com

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IPad and Android

There's an App for That

• 365 Calendar

• Priority Matrix

• Audio Notes

• Voice Reminders

• Pictello Memory Books

• Web Reader

• Functional Visual Schedules

Useful Apps Available on iTunes

• To Do

• Notepad

• Address Book Contacts

• Scientific on The Go Calculator

• Prolo2go

• Accessibility Features

• 365 Day Calendar

• Priority Matrix

• Verbally

• Deluxe Flashcards

• Pictello

• Audio Recorder

• Remember This

Academic And

College Options

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Note taking

• Note taking

• USB Recording Pen

• Audio Pen by Olympus

• Digital Recorder with Transcription from Olympus

• Ergonomic and thicker grip pens

• Live Scribe Digital Pen

Test Taking Accommodation

These should be discuss at the beginning of each

start of the class

• A quite environment with less distraction

• utilizing learning style

• Teacher Oral Examination

• Open Notebook Examination

• Extra Time to reduce anxiousness

Resources for You

Locating the Right Stuff

Identifying the specific needs of the person, and

the possible interventions is a crucial first step.

Some resources that have been found to be useful in locating possible devices:

• www.abledata.org

A searchable database of assistive technology devices,

offering reviews, product information and more.

• www.assistivetech.net

A database of AT devices, with information about

funding, assessments and more

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Assessment and Training

• Courage Kenny Rehabilitation Institute provides

a continuum of services including academics,

vocational, behavioral, community reintegration, inpatient therapy, and much

more. Many professionals have certification as

a brain injury specialist.

• Contact Jen Mundl to discuss vocational or

academic needs at 763-520-0567

• Contact Medical Rehabilitation Representative

for scheduling other medical related needs at

763-520-0345

CONCLUSION

Jen Mundl, ATP, MS, CET

Courage Kenny Rehabilitation Institute

Assistive Technology

jenim@courage.org

763-520-0567

Work Smarter – Not Harder