ProsthesisWare: A new class of software supporting the activities of daily living.

Abstract

To use the microcomputer as a prosthetic tool in rehabilitation has a number of advantages over using it as a tutor for cognitive retraining. As a tool, the microcomputer program directly addresses ecologically relevant issues in activities of daily living. New classes of software like HyperCard™ and MacLaboratory Con-troller©, can be readily customized for each patient's needs. Unlike tutors used for cognitive retraining, rehabilitation tools provide prosthetic support that does not presuppose any required reorganization or restructuring of damaged neural tissue. As this new approach to using microcomputers in rehabilitation is implemented, new types and styles of neuropsychological assessment will need to evolve, especially to provide sequential monitoring for adjustments to various iterations of the computer programs. We used the Macintosh™ computer with ProsthesisWare tools written in HyperCard for its ease and speed of design. The standard user interface relieves a patient's memory overburden by providing external function and sequencing cues. We present the case of Cecelia R., a patient with an expressive aphasia secondary to a traumatic brain injury. The development of successive approximations of a speech prosthesis for her-SpeakEasy©, SpeakEasier©, and SpeakEasiest©-illustrates how new hardware and software capabilities permit the rapid iterative design and redesign of cognitive prosthesis tools. This case also illustrates some limitations of the approach and new requirements that would be placed on the rehabilitation environment. We conclude that the emergence of ProsthesisWare constitutes a new application of microcomputers in rehabilitation that offers utilitarian prosthetic aids for the everyday activities of daily living for a select group of people with cognitive impairments.

Web-Based Assistive Technology Interventions for Cognitive Impairments After Traumatic Brain Injury: A Selective Review and Two Case Studies.

“…The results of many of these interventions have been discouraging (see Cicerone et al, 2000, for a comprehensive review of interventions that do and do not appear to remediate cognitive dysfunction; see Majid, Lincoln, & Weyman, 2004, for a limited but critical review of cognitive rehabilitation interventions for stroke). Therefore, for individuals having persisting disabilities, interventions are typically considered that stress compensatory strategies for task completion (Chestnut et al, 1999; Chute, Conn, DiPasquale, & Hoag, 1988; Cole, Dehdashti, Petti, & Angert, 1994; Levine, Horstmann, & Kirsch, 1992; Rothi & Horner, 1983).…”

A proposal for the use of Bayesian probabilities in neuropsychological assessment.

“…Townes et al (1985) suggested that combining cognitive and affective measures provides a means of determining compensation for neurologic deficits that is more valuable than one which correlates diagnostic profiles with neurologic deficiencies. Chute, Conn, DiPasquale, & Hoag (1988) agreed, noting further that continuing improvements in neuroradiological techniques have decreased the need for localization of brain dysfunction as a primary objective for neuropsychological testing. With specific references to psychiatric cases, Erickson and Binder (1986) advocated testing with a primary goal of enhancing the patient’s functional skills.…”