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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?
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)
