4/2/12

Smart Technology
Practical Applications to Support People with Cognitive-Behavioral Challenges in Transitional Settings
Tony Gentry, PhD OTR/L Department of Occupational Therapy Virginia Commonwealth University logentry@vcu.edu

Ongoing Work

New Projects in Works

VCU ACE (www.vcu.autismcenter.org) Autism Center of Excellence Online instructional ATC videos Online PDFs of fact sheets Focus on school-based accommodations and transition to workforce

NIDRR DRRP iTouch in Job Support research trial in collaboration with DRS TATRC physiological monitoring for sleep in PTSD research trial Smart Homes for state vocational rehabilitation center and McGuire VAMC

Facebook & Pinterest

Functional Cognition
Working Memory Prospective Memory Sustained and Divided Attention Executive Function Speed of cognitive processing Metacognition

Assistive Technology for Cognition

Opportunity to share and comment on new ideas, weblinks, products, successes, presentations, etc.

Please like! Go to Facebook, type in search box, bingo AT for Cognition page on Pinterest

http://www.facebook.com/#!/pages/Assistive-Technology-for-Cognition/175561992516687

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Typical cognitive problems

How These Deficits Affect Us

Memory for names/faces, locales Task Sequencing Multi-tasking Dealing with Distractions Remembering to do things (medications, appointments) Adapting to transitions and changes in routines Dealing with frustration

Remembering to do things (medications, appointments) Memory for names/faces, locales Task Sequencing Multi-tasking Dealing with Distractions Adapting to transitions and changes in routines Dealing with frustration Processing and managing communication Self-awareness and insight Judgment and social skills

How these Affect Our Lives

Low-Tech Cognitive Aids

Inconsistent medication: Hospitalization, decline in health Missing appointments: costs money, jobs and friends Missing bills: Eviction from your home, bill collectors Self-awareness, judgment difficulties: Getting lost, traffic accidents, social problems Task-Sequencing Problems: Job failure, need for supervision Problems multi-tasking or dealing with distractions: Home and community safety, difficulty at work

Behavioral Challenges"

Assistive Technology
People with cognitive-behavioral challenges least likely group to use AT People with autism may prefer computer interaction to human cueing Small AT strategies can be lifechangers Technology is changing rapidly Consumer-based products are especially robust

Speech-Communication Interpreting Non-Verbal Communication Frustration Tolerance Stimming/Unusual Behaviors Mental Health issues Lack of familiarity with appropriate social behaviors in work setting Dealing with customers/co-workers Sensorimotor comorbidities

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School-based AT

Transition Issues:
AT does not follow the person AT not portable for work settings AT outdated AT is disability-identied Change in life roles AT as primary support vs. AT as adjunct What can we do?

Functional Cognition Assessment

Vectoring

Reports of MD, neuropsychologist, teachers and therapists Formalized assessment tools Interview with client and family At home observation during everyday tasks Interest inventory Estimation and confirmation Does this nail fit your hammer? Expectation of fluctuation

Canadian Occupational Performance Measure (COPM) Rivermead Behavioral Memory Test - Extended (RBMT-E) Test of Everyday Attention (TEA) Multiple Errands Test (MET)

Crucial Questions:

Crucial Questions:

Safety at home and in the community

Medication Management Diet & Dining Driving Managing Finances/Bills Personal Supports Potential for school or work Non-cognitive disability issues

Kitchen, bathroom, doors & windows Food safety Street smarts Geographic orientation skills Calling for help Managing frustration

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Crucial Questions:

Insight & Motivation

Other daily living activities What do you most want to do? What solutions have you tried? What seems to be working? Role of caregiver

Time Trial & Error Attention Self-Awareness Goals Self-Efficacy

21st Century Rehabilitation

How ATC Can Help:

Remembering to do things/forward planning Task-Sequencing Waynding Managing Problematic Behaviors & Situations Health Management Safety Communication Home & Money Management Academics Sensory ability accommodations

Person

Place

Task

Thank you!
Tony Gentry, PhD OTR/L Assistant Professor Department of Occupational Therapy Director, Assistive Technology for Cognition Laboratory Virginia Commonwealth University logentry@vcu.edu

4/2/12

Smart Technology
Practical, portable tools

Cognitive Rehabilitation
Emerged and developed alongside personal computing

Tony Gentry, PhD OTR/L Department of Occupational Therapy Virginia Commonwealth University logentry@vcu.edu

Remedial vs. Compensatory Approaches

1980s

1990s

Dawn of Cognitive Rehabilitation Personal computers

Calls for ecologically valid research

Desktop computers as reminder systems and task-sequencing coaches

Where weve been.

Portable Computer Research

Psion Organizer NeuroPage Cell phones PDAs Disability-specific Software for PDA

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2000s

Traditional ATC Roles

Handheld compensatory solutions Distributed-cognition experiments

Reminder systems

Alarm reminders linked to calendars Pagers Digital tape recorders

Task-Sequencing Prompts

Collaborative Contextual approach

Multi-media options

Plain Old Cell Phone

Carry it everywhere Speed Dial for Frequent Calls Text-Messaging Calendar Reminders Contact information Camera Varied features by phone

Onboard tools (all PDAs)

Calendar with reminder alarm prompts To Do List Audio Recorder Notes to Self program Contacts/Address List Alarm Clock Photo Album Video-Playback Tap-learning screen

What can a PDA Help With?

Scheduling/Reminders Time Management Task Sequencing Way-Finding Behavioral Cues Education Video chat with job coach And more.
Samsung Galaxy Note

Smartphones

Apple iphone

Nokia Lumia 900

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Ipod Touch 4

Apple Ipad(s)

Front-rear facing still and video camera Face Time video-calls Built-in microphone Voice-over accessibility Background-running program capability Application Folders Games interactivity

Large icons for dexterity-challenged

Louder speaker for augmentative communication

Larger screen

iPads Generations
Off market

$399

Accessibility
Reads any text onscreen Zooms by touch Mono Audio Gesture simulator All toggled by home button (3x click) New iPad allows dictated emails, notes, etc.

$499

Android Tablets

Windows(7(Tablets(
Acer(Iconia(Tab( Asus(eee( $350:500(

Samsung Galaxy Motorola Xoom Dell Streak Many others

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iPad Killers?

Whats missing

Barnes & Noble Tablet Nook running Android Honeycomb ($199) Kindle Fire running Android Gingerbread ($199)

Phone/ipod have weak speakers Poor visibility in bright daylight Haptic touch USB port for access switches Apps not optimized for Bluetooth switch access
See article

For Less than $100US

People who only need reminders People with more severe impairments who do not have caregivers to help program and maintain more complex tools

Medication Reminders
Pill Dispenser Alarm Pulse rate Blood pressure www.epill.com

Audio Recorders

www.ohdontforget.com
Free web-based text message reminder system for cell phones No repeated reminders Text message charge from provider Can be programmed in anywhere the web is available

Digitally record reminder alarms Tapes can playback at varying speeds Good for note-taking Generally easy to use Various manufacturers

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Google Calendar > Cell phone

Legacy Tools

Text message a calendar reminder Can be used on any cell phone that allows texting
Tony's Old PDA Website

Person Locators
Instamapper (free) Four Square (free) Most smartphones Best with unlimited data plans

GPS:Based(Person(Trackers(
Nu-M8 Lok8u.com

Spark&Nano& Brickhousesecurity.com( Aetrex.com

Lifesaver.org

Smart Home/Ofce

Safety Task Management Environmental Control Communication Comfort

See article

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AT for Cognition on PDA

Remembering to do Things Task-Sequencing Behavioral Adaptation Way-nding Communication Health Management

Thank you!
Tony Gentry, PhD OTR/L Assistant Professor Department of Occupational Therapy Director, Assistive Technology for Cognition Laboratory Virginia Commonwealth University logentry@vcu.edu

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Smart Technology
Prospective Memory & Task Planning
Tony Gentry, PhD OTR/L Department of Occupational Therapy Virginia Commonwealth University logentry@vcu.edu

Time Management

Before

After

ATC at home/worksite

Typical reminders

Medications Wake up Catch bus Clock in at work Breaktime (with timer) Lunch (with timer) Switch from one task to another Clock out and go home Plug in device to charge overnight

Reminders app

Reminder Add-on Apps

Due

Tell Me Later

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Two New Reminder Apps

Time Timer"
for work speed, attention to task, etc.

BugMe!

BugMe!

VoCal

Time%Timer%Custom%Se-ng%

Medication Management

Pillboxie

Medsy

Medication Reminders

Remember to do things & Switch Tasks

Calendar reminders

Explore Calendar Reminders:

Pill Dispenser Alarm

Easy to view in list view Share across devices/pcs

Enter a reminder for 5:00 pm (Go home!)

Explore Reminders app Explore Clock Reminders (ipod touch only)

Pulse rate Blood pressure www.epill.com

Reminders (iOS 5)

Task list + reminder

Clock reminders

Choose a sound Enter a reminder for 10 minutes from now

Variable sound alerts Countdown timer Not available on ipad

Try out a countdown timer (for 5 minutes from now)

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What are you looking for?

Task List options

Easy to Set up? Ability to set wide variety of recurring reminders? Ability to add a note to the reminder? A photo? Variety of sound alerts? How loud is alarm? How long does it sound? Talking alarm? Snooze function? Yes I did it monitor? Countdown timer?

Clocky Rolling Alarm Clock

Task List Considerations

Typical To Do List items

Can your client program her/his own task lists? Can a supervisor or caregiver do so? Can you give your lists titles, so they are easy to locate? Can you check off tasks as they are completed? Is there an auditory option for elementary readers? Can you append a photo or picture for visual learners? Is there a reminder alarm feature? Is it, perhaps, too easy to erase a to do list note?
Step-by-step instructions for any home or work task (dont forget to give the list a title) A list of tasks that need to be done during the day Shopping list A message to self with behavioral advice or a social story With Corkulous, you can add a photo, a map or a drawing With Voice Memo or List Recorder, can add audio with playand-pause functionality for follow-along during a task

Case: 21-year old with Autism Reads well Persistent/consistent Hard worker Polite

Krishnon
Ipod Touch Reminders using Clock feature Task lists using Notes feature Rehearse day using Voice Memo Music at home

Difculty switching tasks Forgets steps of tasks Behaviors

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25

In Assessment

20

Can your client set her/his own alarm reminders? Can an employer or family caregiver set alarm reminders? Most importantly: Can your client hear/read the alarm? When the alarm goes off, does your client respond to it? Does your client do what the alert says to do? Does your client safely stow device during task?

15

Series1 Series2 Series3 10

0 1 2 3 4 5

In Training:

Find out what tasks and activities typically require someone to nag your client to get done. These can be at home or at work. Prioritize these in order of: (1) safety, (2) on time performance, (3) task switching needs First week, set no more than 5-6 reminders for each day Check in to see if client is responding appropriately and consistently to reminders If not, consider: (1) different app, (2) reward system, (3) speaker for device or move it closer (armband?), (4) what else? Vary, increase, adapt as needed to provide just-in-time suite of reminders for daily activities.

In Training

Onboard apps allow setting an alarm reminder that cues you to open a Note with a to do list on it or a tasksequencing video. Make sure the To Do list app you choose is on front page or in Work folder in Tray. Consider using Note taking apps like these to record inspirational or behavioral prompt messages as well. As with reminder alarms, does your client use the Note or To Do list successfully and independently to get work done? If not, what might work better?

Thank you!
Tony Gentry, PhD OTR/L Assistant Professor Department of Occupational Therapy Director, Assistive Technology for Cognition Laboratory Virginia Commonwealth University logentry@vcu.edu

4/2/12

Smart Technology

More mobile AT
Task-Sequence Behavioral Cueing Waynding Social Stories

Strategies for TaskSequencing, Waynding and Behavioral Cueing

Tony Gentry, PhD OTR/L Department of Occupational Therapy Virginia Commonwealth University logentry@vcu.edu

Ipod Touch 4g and iPad 2/new

Visules

Front-rear facing still and video camera Face Time video-calls Built-in microphone Voice-over accessibility Background-running program capability Application Folders Games interactivity

Select a Work-related 5-step Task List Take close-up pix for each step Build task sequence in Visules

HomeRoutine

First-Then

Create a timed task routine for your own Saturday morning this week http:// www.homeroutines.co m/using-homeroutines/ using-routines/ Can you set a timer for your routine?

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Task-Sequencing Powerpoint

Hack Story Kit

Take photos of sequence Create powerpoint with typed prompts Save as movie (Ofce 2010) Export to pda

Free app Picture sequences Captioning and drawing Audio cues

http://www.youtube.com/ watch?v=RSWQkUS4kXk

Video Modeling

Task-Sequencing Apps

Most well-researched of all AT for cognition approaches Rehearse Play and Pause Review See handout

Going Places http:// www.modelmekids. com/iphone-appautism.html 6 locations FREE on App Store

Everyday Skills

Task-Sequencing Video
Best is to show client performing task successfully Can use during task Also pre- post-task for rehearsal/review

Ablelink App 40 activities $39.99

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Waynding

Behavioral Prompts
32-year old woman Group home Autism and Severe OCD Compulsively calls mom for advice up to 6 hours/day

Works better than GPS for many people GPS requires satellite access (and phone plan)

Behavioral Prompts

iPod Touch 4g, Ipads 2/new

19 year old with Autism Medical Supply aide at hospital What to do when people bother you.

Simplied iMovie allows improved editing directly on device http:// www.youtube.com/ watch? v=MEaWuCrI24s&featur e=relmfu

Picture Scheduler

Mini-Cams

Open App Create a reminder prompt for 5 minutes from now Click to add picture Click to select a video

User friendly software Software onboard camera, loads on pc Straightforward editing Not so straightforward transfer to Kindle and Nook Color

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How much do you need?

Video Lab

Text Note Add picture Picture sequence Add audio Video Reminder? Think forward and reverse

Teams of 3 Read your case study Storyboard a task sequence or behavioral prompt Videotape on ipod 4g or iPad 2 Edit

When shooting:

Keep it short Bright light Close ups Try to get it right the rst time Narrate concisely as you go Give it a useful title

We will share and vote! Thank you!

Tony Gentry, PhD OTR/L Assistant Professor Department of Occupational Therapy Director, Assistive Technology for Cognition Laboratory Virginia Commonwealth University logentry@vcu.edu

4/2/12

Smart Technology
Apps for CognitiveBehavioral, Sensory & Communication Challenges
Tony Gentry, PhD OTR/L Department of Occupational Therapy Virginia Commonwealth University logentry@vcu.edu

Accessibility Features

Go to Utilities Settings Accessibility Toggle on/off with 3 taps on bottom button Turn off access features

Apps that Help

" Find My Iphone

Person-locator Seizure tracker Free cellphone access Cognitive challenge games Behavior trackers/cues Augmentative Communication Apps for Sensory issues
Four-Square

Must have Mobile Me account with Apple Must set up App on device you want to locate and another device (pc or mobile device) Can see on map Can send a note Can lock or wipe device

Seizure Tracker
www.epdetect.com Windows mobile

Real-time help

www.epilepsy.com For Iphone or pc

FaceTime (Apple iOS only) Plain old phone

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Cellphone on your PDA

Health Folder

Skype (free) Line 2 (9.95/month) Fring (free) Facetime (touch to touch)

Sleep Hygiene
Zeo ($149) with pcbased sleep coach

Behavioral Apps

iCounselor OCD Anxiety Fear Depression (each is $.99)

Sleep Cycle ($.99)

DoD#app#for#anxiety#

Mood Tracker Pro

Veterans Affairsdeveloped Shows graph of mood changes over time Can link to reminder for periodic check-ins Share with clinician

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Behavior Trackers
Behavior Tracker Pro Skill Tracker Pro Each $29.99 on App Store

Relaxa0on#Apps#

Music Folder

Learning the interface with Games

Bubble Popper screen tapping Labyrinth LE using accelerometer feature Game Center games social interaction

Simple Money Management

Classwork Planning

Expenses 1.99

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Augmentative Communication

Free-standing devices

Confer with SLP to determine the right app for your child Confer with OT for device adaptations Sometimes an AAC hardware will work better Consider school legacy tools

DynaVox Tobii Go Talk Etc.

Proloquo2go

Voice4You
www.voice4uaac. com Iphone, ipad $29.95

On Apple App Store $190 www.proloquo2go.com

Speak it!

$1.99 On ITunes

Free App Runs on Nintendo DS, ipod touch, iphone, ipad www.taptotalk.com Tap to Talk Designer $99.95/year

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Free!

iMean

Large, simplied keyboard Word prediction Speaks text Save to library 4.99

Type-n-Talk

iBaldi

Dragon Dictate

Dragon Go

Sort of Aug Comm.

Conversation Builder Talking Tom Soundnote & Notability

Works much like Siri Searches Google Maps Voice-controlled Internet search Open apps/play music

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Explore Aug Comm Apps

Using the Apps

Age Appropriate? Type of Access? Picture or Words or both? Library of phrases? Ease of use? Choice of voices? Can you hear it?

Practice with each Prioritize your top 3 for a communication-impaired adult Be able to explain your choices

Hearing Impaired
Power of texting Instant messaging In Accessibility panel, assign different vibration patterns to frequent callers (iPhone)

Hearing Impaired

Power of texting Instant messaging Tap Tap App soundAmp

Visually Impaired

Money Reader
Reads U.S. paper money using your ipod/ ipad 2 camera See other Looktel products

http://appadvice.com/applists/show/apps-for-the-visually-impaired Uses Voice Over Accessibility feature

Ariadne GPS

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Thank you!
Tony Gentry, PhD OTR/L Assistant Professor Department of Occupational Therapy Director, Assistive Technology for Cognition Laboratory Virginia Commonwealth University logentry@vcu.edu

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The Evidence for Cognitive Rehabilitation

Smart Technology
Assessment, Training & Follow-Along
Tony Gentry, PhD OTR/L Department of Occupational Therapy Virginia Commonwealth University logentry@vcu.edu

Tabletop process-specific training works sometimes (especially with attention) with some people (especially mildly impaired) Computer-based remedial programs (and most other directtraining efforts) do not transfer to real world settings Compensatory approaches work, and work best when individualized and offered within a supportive context (caregiver training, community follow-along) The strongest evidence for real world effectiveness of a rehabilitation intervention is the use of cognitive prosthetics

Is what we do cognitive rehabilitation?

Interventions Are Best When:

In clinical practice, there is general consensus that cognitive rehabilitation (regardless of the approach taken) should be directed at improving patients everyday functioning and quality of life. (Cicerone, 2007) for decades the field seemed trapped in an internal struggle over whether it is better to focus on training processes, skills, or functional abilities.... Though the struggle is not entirely over, it is increasingly acknowledged that functional changes must be the goal of treatment, and that there are many ways to go about facilitating those functional changes. (Sohlberg & Mateer, 2001) As far as cognitive rehabilitation is concerned, we should be attempting to remediate disability rather than impairment, or, at least, demonstrate that treatment of impairment results in reduction of disability. (Wilson, 1997).

They are person-focused, not discipline-focused Clinicians work without boundary issues Team is able to collaborate and see clients holistically Ultimate goal is self-efficacy and self-regulation within each client s chosen life experience

Holistic Perspective

Service Provider s Role

Assess client needs, tasks and environment Learn the devices Determine best device for client Individualized suite of apps & strategies Train client and caregiver Include in daily organization routine Follow-up consults Gradually diminish supports

Strategies for thinking, memory Environmental adaptations Task simplication, supports

Person

Place

Task

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Assessment

Like any other A.T., consider

FATCAT Tools/Features used now Task requirements Goals/obstacles Familiarity/interest in using AT Human supports

Does client have potential to use a device?

Functional vision Hearing Dexterity Ability to respond to a prompt and perform prompted task Frustration tolerance Awareness of need/Interest in using device

Which tool?

Interface issues

Apple vs. Android vs. Microsoft vs. RIM? Will your clients plain vanilla cell phone do the trick? Pocket-size or tablet-size? Wi- only or cell phone access plan? School, work or all around use? Who will program the thing?

Getting lost in so many onscreen options The device itself as a distractor Where do you put the thing? How do I protect the thing? Saving battery life Tinny, tiny speakers Inputting data

Pimp your Screen

Steve Jobs' Folder Demonstration Recommend: Create a Work folder Place work-related apps in this folder Drag Work folder to tray on bottom so its always visible Move non-work folders to second screen, not in tray Another option: If only a few workrelated apps, place them all in tray and not in a folder (easier to see them that way).

Carrying PDA at work

Pocket Belt clip Armband Desktop Lanyard

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Cases for ipod touch

Turn off battery draining features

Otterbox.com Defender $29.95

Colortunes Walmart $9.95

Turn off battery draining features

More battery savers

Other battery savers

Why Bluetooth?
Set alarm to charge me! at night.

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Speaker solutions

Keyboards*&*Styli*

Jabra $30 (Amazon)

iMainGo $15 (Walmart)

Bluetooth keyboard

Training Method

Theory

Think about ergonomics Think about portability Thumbs or ten ngers?

Logitech di novo

Diffusion of Innovations Instructional Design Cognitive Rehabilitation

Build on Prior Familiarity Repetition and Reinforcement Multi-modal training tools Focus on Real World Needs Formative and Summative Assessment Collaboration and Facilitation

Apple full-size

Set-up & Training

Training
Pre-Test, Provide PDA, load Desktop software, Intro to Data Entry and Calendar
Contacts, Note Pad, Tasks, Memos

Introduce a good basic device Download software to person s pc Introduce reminder alarm function for daily schedule Train family caregiver to trouble-shoot Help person record 4-5 reminders each day for first week

Week 1
Trouble-shooting Add appropriate apps Trouble-shooting Post-test

Weeks 2 and 3

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Support/Follow-Along

On subsequent visits, reinforce reminder alarm function Work through problems Introduce other features, as appropriate

Also consider:

Workplace stimuli Protection of device How will it be carried? Home needs/uses

Notes and To do lists Video-based task cueing Wayfinding tools Accessibility features Don t forget fun

Post-Assessment

Fading Supports

How has A.T. reduced need for supervision? What new goals might be pursued? What other technology may help? If it didn t work, why didn t it?

Is this the right device for this person? Gradually hand-off trouble-shooting to person and caregiver Consider disability-specific software How can the device be leveraged for increased independence at school or on the job? Be aware that new abilities lead to new opportunities Collaborate on new ideas

Personalized Suite
Basic Adaptations

ATC Issues

Dont Forget Portability Durability Fit to Person, fit to tasks Complexity vs. Functionality Abandonment vs. Adaptation Think of your car or tv.

Reminders Task-Sequencing Cue Way-Finding Video Behavioral Management tool Communication or Device Access Adaptations

Protective Case or Belt Clip Simplify Screen for Easy Access Speakers? Keyboard? Behavioral Contract?

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Functional Change COPM Mean Scores

10
9

n = 46
7.83

Comments
I am absolutely amazed at how that device is working. It is incredible! The second it goes off, D___ jumps up and completes his task. I am so excited about the possibilities for his independence and responsibility level. (mother of 14 year old boy with autism)

7
Mean Scores (10-point scale)

6.64

Mean Scores (10-point scale)

2.81

2.54

0
1 Pre-Test and Post-Test 2

0 1 Pre-Test and Post-Test 2

Before I got this PDA, I wouldn t even remember to eat half the time. Now I ve got alarms for my medicines and appointments, my passwords, my homework, even directions to places in town. It makes me feel like maybe I can do things on my own at last.
TBI Group N = 24!

Autism Group N = 22!

(16 year old with Asperger s Syndrome)

FATCAT Themes

Implications - Clinical

Gratitude: At last something helped me! Medication Management: I feel better! Organization: I can keep track of my day, gaining control over my life. Self-efficacy: Being able to do more makes me want to do more.

A brief training intervention with PDAs works Affordable, readily available device No social stigma for user Improves functional performance and self-efficacy Not a one-size-fits all therapy The potential for computers as cognitivebehavioral aids is enormous

Initial Lessons I Learned

Funding AT for Cognition

Medicare: Does not consider consumer products as assistive technology State Rehab Services: Typically, yes, if vocationally relevant Other: Veterans Affairs, pilot school-work transition programs Loan Funds: ACT not particularly expensive

You can t throw these things at people and run You have to provide long-term follow-along Expect needs and goals to change Expect new technologies to offer additional opportunities Collaborate learn from your clients

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Billing and Codes: CPT

Billing and codes continued

ADL/Home Management #97535

activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment (inc home environment/ modif analysis)

Cognition skill Development (3421351)# 97532

Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training)

Community/work reintegration training #97537

Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/ modication analysis, work task analysis, use of assistive technology device/adaptive equipment

Assistive Technology Assessment #97755

To restore, augment or compensate for existing function, optimize functional tasks and/or environmental accessibility (for assessment and reassessment only)

References
Gentry, T. (2010). Gentry, L, Wallace, J, Kvarfordt, C., & Lynch, K.B. (2010). PDAs as cognitive aids for adolescents with autism: Results of a communitybased trial. Journal of Vocational Rehabilitation. 32: 101-108. Gentry, L. (2008). PDAs as cognitive aids for individuals with multiple sclerosis. American Journal of Occupational Therapy. 52: 444-452. Gentry, L. Wallace, J. (2008). A community-based trial of pdas as cognitive aids for individuals with acquired brain injury: Outcome ndings. Brain Injury. 33: 21-27.

Joey

Joey is a 20-year gentleman with autism and OCD, who received a high school certicate one year ago. He is non-verbal, but reads well and understands spoken language. In school he had used a Dynavox for communication, but no longer has the device and has begun to make fewer and fewer efforts at communication in the past year. He has one of the new Nintendo DS-3D portable game devices, and seems to spend most of his time lost in play on complex puzzle games. You have been called in to help him nd, and succeed at, work, and are beginning a job trial with Joey at a local pet store that has several employees with disabilities. Joey is being asked to do several complex tasks at the pet shop. In the morning, he removes mice and gerbils from their cages, puts them in boxes, and cleans their cages, replacing old bedding with new, and then putting the animals back. He then feeds and waters them. There are ten cages in all. If he moves through the task steadily, it should take most of the morning to get this done. If a customer asks for help, he is expected to respond kindly and offer them help or direct them to someone who can help. In the afternoon, he helps the shop owner manage reptiles. Though he doesn't have to touch the animals, he is expected to wash down their glass tanks (there are 12 tanks in all). In his rst week on the job, Joey does well when working directly with the owner, but cannot seem to stay on task during his morning routine. He wanders off to look at the sh, or compulsively cleans one cage until it is spotless (then starts all over again on it), and he has never cleaned more than three cages in a morning yet. If he cannot learn to work independently at this task, he cannot graduate to more varied tasks and may lose his job. He seems to be aware of this, and it is making him increasingly anxious. There is another problem. Joey's parents both work, and he needs to be able to take care of his morning routine and walk to the pet shop on time for work. You have had to meet him at home every day this week, and walk with him to the shop, but he has been late every day.

Thank you!
Tony Gentry, PhD OTR/L Assistant Professor Department of Occupational Therapy Director, Assistive Technology for Cognition Laboratory Virginia Commonwealth University logentry@vcu.edu

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3 Case Studies
Putting it all together

Johnathan

28-year old retired OIF ofcer Multiple concussion blast TBI PTSD Pre-Med student at VCU

Tony Gentry, PhD OTR/L Department of Occupational Therapy Virginia Commonwealth University logentry@vcu.edu

Situation

iCal for Appointments iStudiezPro for Homework Notability for Notetaking and lecture recording (with stylus) Sometimes photographs assignments from chalkboard

iPad 2

Ambitious and over-scheduled Must get excellent grades for med school Missing assignments/appointments Difculty following lectures in busy classroom Hyper-vigilant and high anxiety Forgets meds so sleeps poorly; fear of overmedicating

Health apps

Peripherals

Pillboxie for pills PTSD Coach for tracking symptoms Breathe-2-Relax

Grifn Survivor Extreme Case - $58 Olympus m-2 noisecancelling microphone - $25 Walmart stylus - $12

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All As winter semester

Case Study
Stephanie Lau, VCU RRTC and her client Beth

Khan Academy QuickOfce Pro Dropbox

57-year old Virginia Employment Commission le clerk

Situation

Contacts

Environmental Adaptations Organized work ow with written instructions But still required close supervision for:

Switching tasks, way-nding in building, anxietymanagement, changes in routine, transportation safety

Task Notes

Reminders

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Videos

Anxiety Management

Simply Being Guide meditation app with music and voice Timer .99 on iTunes Store

Entertainment

Result

Manages bus difculties with reminders, phone, and music Moves from task to task on time (alerts) Knows what to do (notes) Finds her way, observes appropriate, safe behaviors (videos) Relaxation and anxiety-management (apps and music)

18

16

14

12

10 Series1 Series2 8 Series3

Job Coach Project Search St. Marys Hospital Richmond

0 1 2 3 4 5 6 7

Alissa&Molinelli&

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Annie

Annies job trial

20 year old with Downs Syndrome and ASD dx High school certicate Does not read, tell time, or understand calendar Can follow a visual schedule, but needs direct supervision with task transitions, changes in routine and distractions Generally sociable, but can tantrum Custodial work in hospital lactation room Cleans computers, COWs, refrigerator, folds towels and gowns, etc. 5 days/week, 5 hour days, $8.00 hour Participated in Project SEARCH training On job one month

Issues to address
Clock in/out, lunch and work breaks Different tasks on alternating days Transition between tasks independently Deal with disruption of routine Frustration when she doesnt know what to do Managing bus ride to/from work

iPod Touch?

Reminders

Pink & Purple Days

Spoken reminders so no need to read screen Reminders spoken by Annie herself for ownership of task Disney tune at days end!

Created purple and pink calendars on iCal Created an all-day event for each day She opens iCal with one tap and sees the day highlighted in pink or purple She goes to Storykit and opens either the pink or the purple story to cue her task sequences

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Storykit Task-Sequencing

i-Reward

Reward Games

FaceTime

Ask questions of job coach Job coach can check in virtually

Simplify & Personalize Screen

Summary

iCal to nd out which alternating work day Storykit to choose appropriate tasksequencing book i-Reward to get a star for good behavior Game play can be used as a reward Reminder alarms using VoCal app for cues during the day Reminder at home to charge me! Communicate at work via Facetime Customize interface for ease of use

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Outcome

25

20

Initial iTouch setup and training required about 4 hours Annie can self-manage device Job coach immediately recorded reduction of direct supervision hours But then, she lost the device!

15

Series1 Series2 Series3 10

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Lanyard case

Discussion?

Your turn

Groups of 4 Read case study Consider your options Choose a device What strategies/apps will help?

Create a work folder Put folder in tray Add the apps you will use How will you protect device? Other peripherals? Plan to discuss your solution.

Thank you!
Tony Gentry, PhD OTR/L Assistant Professor Department of Occupational Therapy Director, Assistive Technology for Cognition Laboratory Virginia Commonwealth University logentry@vcu.edu