Long-term maintenance of smartphone and PDA use in individuals with moderate to severe memory impairment

Early mobile app training proficiency predicts how well memory-impaired individuals learn to use digital memory aids in the real world

Functional memory impairment following acquired brain injury can lead to decreased independence. External memory aids such as smartphones can be highly effective compensation tools, but cognitive deficits may create barriers to implementation in daily life. The present study examined predictors of real-world use of mobile calendar applications for memory compensation in an acquired brain injury sample. A retrospective chart review was completed from an outpatient rehabilitation program, extending 15 years into the past, yielding data from 34 eligible participants. All participants demonstrated skill learning of the calendar function in their digital device and subsequently completed the generalization phase of training, which is focused on real-world implementation (measured through prospective memory tasks). The results showed that the length of time required for skill learning of mobile calendars (event entry or responding to alerts) was not predictive of the duration of generalization training. Initial training performance for responding to alerts, but not event entry, was a significant predictor of the duration of generalization training needed to complete the program. A secondary analysis with a subset of the data revealed that individuals with additional executive deficits took significantly longer to complete generalization training compared to those with a more focal memory impairment.

Memory rehabilitation: restorative, specific knowledge acquisition, compensatory, and holistic approaches

Memory impairment following an acquired brain injury can negatively impact daily living and quality of life—but can be reduced by memory rehabilitation. Here, we review the literature on four approaches for memory rehabilitation and their associated strategies: (1) the restorative approach, aimed at a return to pre-morbid functioning, (2) the knowledge acquisition approach, involving training on specific information relevant to daily life, (3) the compensatory approach, targeted at improving daily functioning, and (4) the holistic approach, in which social, emotional, and behavioral deficits are addressed alongside cognitive consequences of acquired brain injury. Each memory rehabilitation approach includes specific strategies such as drill and practice (restorative), spaced retrieval (knowledge acquisition), memory aids (compensatory), or a combination of psychotherapy and cognitive strategies (holistic). Past research has demonstrated mixed support for the use of restorative strategies to improve memory function, whereas knowledge acquisition strategies show promising results on trained tasks but little generalization to untrained tasks and activities of daily living. Compensatory strategies remain widely used but require intensive training to be effectively employed. Finally, the holistic approach is becoming more widespread due to improvements in psychosocial wellbeing, yet there are considerable resource and cost requirements. Several factors can influence rehabilitation outcomes including metacognition and emotional disturbances. Considerations for future research to improve the applicability of strategies for memory rehabilitation include assessing memory impairment severity, examining memory needs in daily life, and exploring the long-term effects of memory rehabilitation.

Supporting People with Acquired Brain Injury to Use a Reminding App; Narrow-deep vs. Broad-shallow User Interfaces

People with memory impairments following an acquired brain injury stand to benefit from smartphone apps as memory aids. Due, in part, to usability issues they use smartphone-based reminding less than the general population. Evidence suggests this group may benefit from user interface (UI) designs with more screens with less information per screen (narrow-deep UI) rather than fewer screens with more information per screen (broad-shallow UI). This study compared the difference in speed, accuracy, guidance needed, and task load for 32 people with acquired brain injury when setting reminders using narrow-deep and broad-shallow UI. They were also given cognitive assessments (measuring selective attention, executive functioning, and overall executive and memory ability) and interviewed about their UI preference. There was a significant difference in accuracy; participants were less accurate (they made two more errors on average for every three reminders set) using a broad-shallow compared to narrow-deep UI. The reason for this difference was that participants omitted more information when using broad-shallow UI. There were no differences in speed, guidance required, and overall task-load. Participants with better selective attention and more experience with smartphones benefited the most from narrow-deep UI compared to broad-shallow UI. Most participants preferred one UI over the other. Those who preferred narrow-deep found it easier to use, that they missed less information and liked having one piece of information at a time. Those who preferred broad-shallow found it easier to review the information and felt less likely to lose track. The findings can inform that implementation of UI choices to make apps more accessible for those with cognitive impairments.

Mobile app learning in memory intervention for acquired brain injury: Neuropsychological associations of training duration

Memory impairment is a common consequence of acquired brain injury, often leading to functional difficulties day-to-day and decreased independence. Memory Link is a theory-driven training programme for individuals with moderate-to-severe memory dysfunction, which enables the acquisition of digital device skills for functional compensation. The present study examined how neuropsychological functioning and initial training performance contribute to training duration in our outpatient memory rehabilitation programme. A retrospective chart review was conducted, extending 12 years into the past, yielding data from 37 eligible participants. All participants demonstrated skill learning of the calendar function in their digital device to the criterion point. The results showed that performance on neuropsychological tests of explicit memory (e.g., CVLT-II, BVMT-R), processing speed (e.g., Digit Symbol Coding, Trail Making sequencing), executive functioning (e.g., Trail Making switching), and perceptual ability (i.e., Block Design) were significantly associated with training duration to learn the core steps of calendar use. Furthermore, linear regression revealed that initial training performance was a significant predictor of training duration. Lastly, profile of cognitive impairment, with regard to severity of memory functioning and the presence of additional deficits, was found to be a significant factor contributing to how many training trials were required to learn application skills.

Designing ApplTree: usable scheduling software for people with cognitive impairments

BACKGROUND

Smartphone reminding applications can help overcome memory difficulties experienced by people with acquired brain injury (ABI). Cognitive difficulties with memory and attention make entering reminders into a device, and remembering to set reminders, challenging for this group. ApplTree is a reminding app with features that aim to address challenges. One app feature was push notifications (asking "Do you need to set any reminders?") to support people to initiate use of the app to set reminders. Another app feature was a customisable user interface design to support attention and short term memory during reminder setting.

METHODS

In a mixed-methods user study, five people with self or other reported memory impairment following ABI used ApplTree for at least 4 months. They received push notifications for at least 2 months and no push notifications for at least 2 months. Monthly participant interviews provided insight into user interface preference, app use, and push notification acceptability.

RESULTS

Receiving four Push notifications per day doubled number of daily reminders set and four of the five participants found receiving them to be acceptable. This long-term field study uncovered issues relevant for clinicians and designers, including insights into the potential benefits of different user interface designs, the impact of family members on app use, and the importance of perceived need influencing use and acceptance.

CONCLUSIONS

Feedback provided insight into future considerations when designing reminding apps and using them in neuropsychological rehabilitation. This work highlights the benefit of user-led research into accessible design and use of assistive technologies.IMPLICATIONS FOR REHABILITATION"Unsolicited" push prompts are an easy to implement feature of reminding technology that is useful and acceptable for people with ABI in community rehabilitation.Observations provide insights about how people with ABI make use of reminding apps over time. This can inform those designing apps or providing reminding technology as part of neuropsychological rehabilitation.Participants differed on their preference of the two user-interface designs available in ApplTree. This highlights an area for future research because currently available reminding apps have a broad-shallow design which may not always be appropriate for people with ABI.

Neuropathology of a remarkable case of memory impairment informs human memory

Kent Cochrane (K.C.) has been investigated by researchers for nearly three decades after intracranial trauma from a motorcycle accident at age 30 resulted in a striking profile of amnesia. K.C. suffered severe anterograde amnesia in both verbal and non-verbal domains which was accompanied by selective retrograde amnesia for personal events experienced prior to the time of his injury (episodic memory), with relative preservation of memory for personal and world facts (semantic memory), and of implicit memory. This pattern of spared and impaired memory extended to spatial memory for large-scale environments and beyond memory to future imagining and decision-making. Post-mortem brain findings at age 62 included moderate diffuse atrophy, left orbitofrontal contusion, left posterior cerebral artery infarct, and left anterior frontal watershed infarct. Notably, there was severe neuronal loss and gliosis of the hippocampi bilaterally. The left hippocampus was severely affected anteriorly and posteriorly, but CA2, CA4, and the dentate gyrus (DG) were focally spared. There was associated degeneration of the left fornix. The right hippocampus showed near complete destruction anteriorly, with relative preservation posteriorly, mainly of CA4 and DG. Bilateral parahippocampal gyri and left anterior thalamus also showed neuron loss and gliosis. There was no evidence of co-existing neurodegenerative phenomena on beta-amyloid, phosphorylated tau, or TDP-43 immunostaining. The extent of damage to medial temporal lobe structures is in keeping with K.C.'s profound anterograde and retrograde amnesia, with the exception of the unexpected finding of preserved CA2/CA4 and DG. K.C.'s case demonstrates that relatively clean functional dissociations are still possible following widespread brain damage, with structurally compromised brain regions unlikely to be critical to cognitive functions found to be intact. In this way, the findings presented here add to K.C.'s significant contributions to our understanding of clinical-anatomical relationships in memory.

Efficacy of memory aids after traumatic brain injury: A single case series

BACKGROUND

Individuals living with traumatic brain injury commonly have difficulties with prospective memory-the ability to remember a planned action at the intended time. Traditionally a memory notebook has been recommended as a compensatory memory aid. Electronic devices have the advantage of providing a cue at the appropriate time to remind participants to refer to the memory aid and complete tasks. Research suggests these have potential benefit in neurorehabilitation.

OBJECTIVE

This study aimed to investigate the efficacy of a memory notebook and specifically a smartphone as a compensatory memory aid.

METHODS

A single case series design was used to assess seven participants. A no-intervention baseline was followed by training and intervention with either the smartphone alone, or a memory notebook and later the smartphone. Memory was assessed with weekly assigned memory tasks.

RESULTS

Participants using a smartphone showed improvements in their ability to complete assigned memory tasks accurately and within the assigned time periods. Use of a smartphone provided additional benefits over and above those already seen for those who received a memory notebook first.

CONCLUSIONS

Smartphones have the potential to be a useful and cost effective tool in neurorehabilitation practice.

The smartphone in the memory clinic: A study of patient and care partner's utilisation habits

Smartphones have potential as cognitive aids for adults with cognitive impairments. However, little is known about how patients and their care partners utilise smartphones in their day-to-day lives. We collected self-reported smartphone utilisation data from patients referred for neuropsychological evaluations (N = 53), their care partners (N = 44), and an Amazon Mechanical Turk control sample (N = 204). Patient participants were less likely to own a smartphone than controls, with increasing age associated with less utilisation of smartphone features in all groups. Of the patients who owned smartphones, spontaneous use of cognitive aid features (e.g., reminders and calendars) occurred on only a monthly-to-weekly basis; by comparison, patients reported utilising social/general features (e.g., email and internet) on a weekly-to-daily basis. Individuals referred for geriatric cognitive disorder evaluations were less likely to own and use smartphones than individuals referred for other reasons. Care partners reported using their smartphones more frequently than control group adults, with 55% of care partners endorsing utilising their device in caring for the patient. Building upon existing smartphone use habits to increase the use of cognitive aid features may be a feasible intervention for some patients, and including care partners in such interventions is encouraged.

Virtual peer-delivered memory intervention: a single-case experimental design in an adolescent with chronic memory impairment

BACKGROUND

Children and adolescents with chronic memory impairment may develop coping strategies that enable functioning, yet these often remain undetectable using traditional psychometric measures. Personalized intervention studies that promote the use of such strategies designed specifically for use by this young cohort are scarce.

OBJECTIVE

To investigate the effect of a novel virtual reality peer-delivered memory intervention on the everyday functioning and well-being of SE, a 17-year-old female with a history of chronic verbal memory issues, impaired autobiographical event recall and elevated mood symptoms.

RESEARCH DESIGN

A single-case ABA experimental design study was used to assess change.

METHODS

Following initial baseline assessment using objective neuropsychological and subjective functional questionnaires and intervention training, case SE used the intervention daily for 3 weeks before repeating key outcome measures.

RESULTS

Using non-overlap of all pairs and qualitative feedback analysis, the results revealed a significant increase in event recall and self-reported positive changes to levels of everyday functioning.

CONCLUSION

Supporting autobiographical event recall and prospective memory via a virtual peer-delivered intervention may lead to reduction in cognitive load, and benefit overall well-being and everyday functioning.

Psychosocial Issues in Geriatric Rehabilitation

Geriatric patients present multiple age-related challenges and needs that must be taken into account during the rehabilitation process to achieve expected goals. This article examines the importance of identifying and managing psychosocial issues commonly observed in older adults and presents strategies to optimize their rehabilitation process. Depression, anxiety, fear of falling, adjustment issues, neurocognitive disorders, and caregiver support are discussed as a selection of factors that are relevant for geriatric patients undergoing rehabilitation. An argument is made for the importance of comprehensive geriatric assessment in older adults to identify salient issues that may impact rehabilitation and quality of life.

First steps in designing an all-in-one ICT-based device for persons with cognitive impairment: evaluation of the first mock-up

Background

This project Smart Assisted Living involving Informal careGivers++ (SALIG) intends to develop an ICT-based device for persons with cognitive impairment combined with remote support possibilities for significant others and formal caregivers. This paper presents the identification of the target groups’ needs and requirements of such device and the evaluation of the first mock-up, demonstrated in a tablet.

Methods

The inclusive design method that includes end-users in the design process was chosen. First, a scoping review was conducted in order to examine the target group’s need of an ICT-based device, and to gather recommendations regarding its design and functionalities. In order to capture the users’ requirements of the design and functionalities of the device three targeted focus groups were conducted. Based on the findings from the publications and the focus groups a user requirement specification was developed. After that a design concept and a first mock-up was developed in an iterative process. The mock-up was evaluated through interviews with persons with cognitive impairment, health care professionals and significant others. Data were analysed using content analysis.

Results

Several useful recommendations of the design and functionalities of the SALIG device for persons with cognitive impairment were identified. The main benefit of the mock-up was that it was a single device with a set of functionalities installed on a tablet and designed for persons with cognitive impairment. An additional benefit was that it could be used remotely by significant others and formal caregivers.

Conclusion

The SALIG device has the potentials to facilitate everyday life for persons with cognitive impairment, their significant others and the work situation for formal caregivers. The results may provide guidance in the development of different types of technologies for the target population and for people with diverse disabilities. Further work will focus on developing a prototype to be empirically tested by persons with cognitive impairment, their significant others and formal caregivers.