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

Abstract

Objective: Assistive technology for cognition (ATC) is reviewed and 2 case studies presented. Participants: Study 1, a 19-year-old man, with topographical disorientation after traumatic brain injury (TBI); Study 2, a 71-year-old woman with cognitive declines associated with TBI and a pre-injury history of chronic ischemic changes. Design and Interventions: To assess ATC intervention, Study 1 used an ABAЈ design for a navigation task; Study 2 used a modified ABAB design for setting an alarm clock. Main Outcome Measures: Study 1, average errors per route; Study 2, average errors per task substep and number of substeps attempted. Results: For Study 1, navigation errors reduced with ATC; without ATC, partial improvement was maintained, with greater intertrial variability. For Study 2, performance errors reduced with ATC and all substeps were completed; without ATC, errors persisted, but declined across trials, suggesting learning. Conclusions: ATC interventions can facilitate functional performance and contribute to learning of specific adaptive skills. Wireless, interactive, Web-based interventions appear particularly suited to tasks in the home and community, permitting remote intervention and monitoring of task status.

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“…During B trials, the number of error was reduced. During A′ trials, the number of errors was similar to B trials but more variable [5].…”

“…Specifically, a series of single-trial "blocks" were introduced, with the client alternating between cued performance of the task and independent performance. The results are presented in Figure 10, adapted from Kirsch et al [5]. For successive alternating trials, her performance during cued trials was characterized by consistently fewer errors.…”

“…Learning over time was evidenced, even during the noncued condition. However, her improvement was fragile, with deterioration during the last two study trials for reasons independent of intervention (specifically, she was anxious about a family trip being planned for later on the day of testing, resulting in markedly reduced attention), but the pattern of improved performance with cueing was maintained [5].…”

“…In effect, these early studies simulated later ICue features, so that the feasibility of providing interactive cueing on a PDA could be assessed [5]. Single-case pilot studies were conducted to examine whether patients with significant cognitive impairments could interact effectively with a PDA and whether the instruction sets presented by the PDA could facilitate task performance.…”

“…Such devices can remediate prospective memory limitations by reminding someone to perform a task at the appropriate time. A person may also need assistance with multistep activities because of problems remembering the steps in the task, problems with sequential processing (e.g., add flour and butter before adding water), or other difficulties [5][6]. Therefore, people may also benefit from a taskguidance system that provides instructions in sequence.…”