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 commonly called "cognitive orthotics," which means "a device that supports weakened, aberrant, or deficient 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 remembering tasks increased from 37% to 86% in 12 weeks. When the paging system was discontinued for

2-4 weeks, participants continued to be 76% successful. This suggests that some of the participants were able to use the device for a short time and continue to meet daily demands without its use. However, 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 randomized controlled cross-over trial with 143 participants. 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% successful 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 system allowed the participants to perform more tasks than they did without the paging system.

Evans et al. (2003) reported that the four most common 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 vibration 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 delivery 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 individual 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 individual'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 impairments include medical alert tags and personal emergency response systems. The medical alert tag conveys information, such as allergies, when the individual is unable to remember the information. The tag may also provide the person's name and phone number, which is useful if he or she becomes disoriented and lost. A personal emergency response system provides a quick link to help for a person with limited memory or problem solving abilities (Federal Trade Commission for the Consumer and American Association of Retired Persons, 2004). These systems typically include a button on a necklace or bracelet that the individual wears, and a console that is connected to the person's telephone. When the button is pressed, a call is placed to a response center. The response center operator can answer questions, provide reassurance, or in an emergency, send help.

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