A person who has survived a stroke or TBI may have residual cognitive impairments that include: lan- guage impairments, shortened attention span, impaired short-term memory, poor insight to the extent of deficits, unilateral neglect, or difficulty completing tasks from start to finish and following instructions (NINDS, April 21, 2003).
Figure 10.1. Grab bars installed around toilet to assist with impaired balance.
AT for language and cognition
At least 25% of stroke survivors have some form of aphasia (American Speech–Language–Hearing Asso- ciation (ASHA), 2004) (NINDS, April 21, 2003). There are three major types of aphasia: receptive aphasia, expressive aphasia, and global aphasia (Volume II, Chapter 26). With receptive aphasia a person has diffi- culty understanding what is said to them. With expres- sive aphasia the person has difficulty communicating their thoughts to a listener. These symptoms may range from mild to severe depending on the location and extent of brain damage. Expressive and recep- tive aphasia do not exist in isolation. Often someone who is diagnosed with one form of aphasia will have mild symptoms of the other. When both types of aphasia are severe, it is called “global aphasia.”
Currently, there are no assistive devices to help persons with receptive aphasia understand what is being said to them. However, a medical alert tag may be beneficial so that others understand the individual has a language impairment. People with expressive aphasia may use communication boards and computer systems to communicate with others (Mann and Lane, 1995).
AT for memory
Memory impairment is one of the most common residual deficits following a brain injury, such as stroke or TBI (Volume II, Chapter 29). The use of AT to compensate for memory deficits may require that the individual remember to use the memory device, such as a calendar, notebook, memory journal, or date book. Assistive devices for memory are com- monly called “cognitive orthotics,” which means “a device that supports weakened, aberrant, or defi- cient cognitive functions” (Bergman, 2002).
Wilson et al. (1997) studied the use of electronic devices to help people with brain injuries remember appointments, medications, and other daily events. With the use of an electronic paging system, Wilson found that participants’ rate of success in remem- bering tasks increased from 37% to 86% in 12 weeks. When the paging system was discontinued for
2–4 weeks, participants continued to be 76% suc- cessful. This suggests that some of the participants were able to use the device for a short time and con- tinue to meet daily demands without its use. How- ever, some individuals required long-term use of the electronic device.
In a follow-up study of electronic paging systems, Wilson et al. (2001) conducted a 14-week random- ized controlled cross-over trial with 143 partici- pants. Half of the participants (Group A) received the paging system for the first 7 weeks of the study and then discontinued use of the paging system the last 7 weeks. The other group (Group B) did not use the paging system until the last 7 weeks of the study. At the end of the first 7 weeks, Group A was 74% suc- cessful in remembering daily tasks compared to 48% for Group B. Similarly, at the end of the last 7 weeks, Group B was 76% successful compared to 62% for Group A. This suggests that the paging sys- tem allowed the participants to perform more tasks than they did without the paging system.
Evans et al. (2003) reported that the four most com- mon memory interventions for people with brain injury are a wall calendar/chart, notebook, list, and appointment diary. However, these methods were considered not as effective as less-used electronic systems. Four factors associated with memory-aid usage were found: being less than age 30 at time of injury, having a more recent injury, higher current intellectual ability, and having better attention skills. People who do not possess these characteristics may require more support in learning to use memory aids. Paging systems appear to work well for people with brain injury. Typically, the system pages the person when a certain task needs to be performed. The prompt displayed on the screen can be worded so that it is meaningful to the user. The user may set the paging system to alert with a beep and/or vibra- tion when a text message is delivered.
An example of a paging system for persons with memory impairment is the NeuroPage (Oliver Zangwell Centre, 2005). The caregiver provides NeuroPage with the appropriate messages and deliv- ery times, which can be updated as needed. After receiving the information from the caregiver,
NeuroPage automatically sends messages to the individual’s pager at the appropriate times. The indi- vidual presses one button and reads the message.
ISAAC is an example of another cognitive orthosis (Cogent Systems, Inc, 2005). The ISAAC device is wearable and battery powered. This device has a pressure sensitive screen that the user touches when a message is delivered. Like a paging system, ISAAC delivers prompts in the forms of auditory speech, text, checklists, or graphics to the user at the appropriate time of day.
The planning and execution assistant and trainer (PEAT) uses artificial intelligence on a PDA to help people with brain injury function independently (Levinson, 1997). The program helps the individual plan their day, taking into consideration alternative steps in completing tasks. PEAT comes up with a best plan to complete all steps. Then PEAT provides cues to the user assisting them to complete the steps. The user tells PEAT when a step has been completed or if the user requires more time. As a result, PEAT alters the plan based on the user’s input.
Current applications and devices that can be used to assist people with a brain injury in completing daily activities have been reviewed recently (LoPresti, 2004). Some of the devices and systems include: customized computer systems adapted to the indi- vidual’s needs, use of sensors and switches to detect the task the person is performing and providing cues to assist the person in its completion, and paging systems.
Other devices used by people with memory