Chp 17 AT for cognitive Augmentation

cognitive assistive technologies (CATs)

is an entire system of hardware, software, and personal assistance that is individualized to meet specific cognitive needs.

The goal of these technologies contrasts with the strategy followed in many interventions for cognitive impairment:

to avoid risky behaviours through physical restriction of behaviour (e.g., removal of individual from situation), medications, or behaviour modification

Gillespie et  al. (2012) examined the relationship between CATs and cognitive function using a systematic review. Using the definition of CATs as

“any technology which compensates for cognitive deficit during task performance”

The WHO International Classification of Functioning, Disability and Health (ICF) (see Chapter 1) was used to categorize the cognitive domains that were being assisted and the tasks being performed. ICF classification of “activities and participation” (d110-d999) includes

learning and applying knowledge, general tasks and demands, communication, mobility, self-care, domestic life, interpersonal interactions, major life areas, and community, social, and civic life.

To apply the HAAT model, a desired activity is identified. For example, the activity might be

making a bed, using a sequence of steps

The context would also be identified, and in this example, it is

the home

If a person has an intellectual disability that affects their ability to remember the required sequence of steps to make a bed, then a _____ might be helpful

Prompting device

Perception is

The interpretation of sensory information received through our eyes, ears, and skin.

Used to achieve sequencing steps

Cognitive impairments that affect perception limit an individuals ability to use information from the environment to assist with daily activities

Attention is

The ability to focus on a particular task

Signal detection is a process by which an individual must detect the appearance of a particular stimulus. We can detect a signal in two ways

Vigilance: refers to paying close and continuous attention over a prolong period in order to detect a signal

Sustained attention: similar to vigilance but there isnt a competing stimulus present

Attention includes

Signal detection, vigilance, search, selective attention, divided attention

Memory includes

Encoding, storage, sensory memory, short term memory, long term memory, retrieval, implicit memory, explicit memory, recall, recognition

Our awareness of our own identity and that of others in our environment is called

Orientation to person

Is commonly affected in disorders such as dementia and TBI where people forget who are others and themselves

A simple AT that can aid orientation to person is a card listing the persons address and phone number that can be presented to a passerby if the person becomes lost

Knowledge representations help us

relate to things, ideas, and events. The mental representation of facts (e.g., gravity makes things fall), objects (e.g., our house or car), and skills (e.g., how to wash our hands) is also related to how information is stored in memory. Declarative knowledge is what allows us to know what an object is (e.g., a ball.) Procedural knowledge allows us to correctly remember a sequence of operations necessary for performance of a task or procedure (e.g., tying a shoe).

If the objects, concepts, or thoughts to be organized have a numerical relationship, then the sorting task is called

sequencing (e.g., items to be placed in the correct numerical order). Sequencing could refer to the steps required to set the table, make a bed, or take a bus to work. Assistive technologies exist that can help individuals who have difficulty sequencing

Deductive reasoning is

a process by which an individual tries to draw a logically certain and specific conclusion from a set of general propositions. For example, when using an assistive device that requires touching a screen location (a button) to create an action, the statements, “All buttons make something happen when you push them” and “This is a button” leads to the conclusion, “Something will happen if this button is pushed.”

Inductive reasoning is

s a process by which an individual tries to reach a probable general conclusion, based on a set of specific facts or observations. This conclusion is likely to be true based on past experience, but there is no guarantee that it will absolutely be true

General learning refers to

the basic ability to acquire knowledge, skills or attitudes used as a necessity for the more specific types of learning: mathematics, reading, and writing.

DISORDERS THAT MAY BENEFIT FROM COGNITIVE ASSISTIVE TECHNOLOGIES Cognitive skills may be compromised as a consequence of a number of disorders. Congenital disorders (those present at birth) include

intellectual or developmental disorder (DD), learning disorder (LD), attention deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD).

Acquired disorders that

can lead to cognitive limitations include dementia, traumatic brain injury (TBI), and cerebral vascular accidents (CVA).

There are other conditions that are typically thought of in terms of their motor limitations that also may have some cognitive involvement.

Cerebral palsy (CP) is primarily a motor congenital disorder that may have a concurrent intellectual disability. In addition to the progressive motor limitations, multiple sclerosis (MS) may result in cognitive involvement and include behaviour changes as the disease progresses.

People with intellectual disabilities have significant limitations in intellectual functioning and in adaptive behaviour originating before the age of

18

Intellectual functioning includes learning, reasoning, and problem solving.

Adaptive behaviours include the skills of reading and writing, social skills such as the ability to follow rules, and practical skills like personal care. I

If symptoms develop after age 18, the current diagnosis is

dementia (alternatively described as neurocognitive disorder). When it is associated with aging it may be due to Alzheimer’s disease

The term developmental disorder (DD) is broader than intellectual disability, but it can encompass some of the same characteristics. DD refers to

severe, chronic impairment of an individual that (1) is attributable to a mental or physical impairment, or combination of mental and physical impairments; (2) is manifested before the individual attains age 22; (3) is likely to continue indefinitely; (4) results in substantial functional limitations in 3 or more of the following areas of major life activity: (I) Self-care, (II) Receptive and expressive language, (III) Learning, (IV) Mobility, (V) Self-direction, (VI) Capacity for independent living, (VII) Economic self-sufficiency; (5) reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated

Learning disorders are impairments in which the person has near-typical mental abilities in general but a deficit in

the comprehension or use of spoken or written language. These disorders may be manifested as a significant difficulty with reading, writing, reasoning, or mathematical ability

Attention deficit hyperactivity disorder (ADHD) is defined as a pattern of

inattention, hyperactivity, and/or impulsivity that is more frequent or severe than for typical people of a given age

ASD is a developmental disorder characterized by

varying degrees of impairment in communication and social interaction skills or the presence of restricted, repetitive, and stereotyped patterns of behaviour.

A commonly used definition for autism spectrum disorder is that of the Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) (American Psychiatric Association (APA), 2000), which classifies ASD as a pervasive development disorder (PDD). As the term implies, this disorder covers a wide spectrum of conditions, with individual differences in number and kinds of symptoms, levels of severity, age of onset, and limitations with social interaction

Major subtypes of ASD include autistic disorder, Asperger’s syndrome, Rett syndrome, childhood disintegrative disorders, and PDD not otherwise specified (NOS).

Dementia is best defined as

a syndrome, or a pattern of clinical symptoms and signs, that can be defined by the following three points: (1) decline of cognitive capacity with some effect on day-to-day functioning, (2) impairment in multiple areas of cognition (global), and (3) normal level of consciousness