Transcript Thinking About Thinking…. - University of South Carolina

Break the Barriers!
Using AT to Increase Independence for persons with brain injury or
cognitive disabilities
Elaine Phillips, MSP, CCC/SLP
Outpatient Brain Injury Program
Roger C. Peace Rehabilitation Hospital
Greenville 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
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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
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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…
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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…
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A Comparison of Four Prompt Modes for Route Finding for Community Travellers
With Severe Cognitive Impairments
By 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