Assistive Technology
and Traumatic Brain Injury
• The views expressed in this presentation are
those of the authors and do not reflect the
official policy of the Department of the Navy,
Army, or Air Force, the Department of Defense,
nor U. S. Government.
• This presentation does not imply any Federal /
DOD endorsement.
Disclosure
• VA Central Office Contract to the University of
Pittsburgh to provide support to VA
Polytrauma Centers for Assistive Technology
A Review:
Assistive Technology Device
“…any item, piece of equipment, or product system,
whether acquired commercially, modified, or
customized, that is used to increase, maintain, or
improve functional capabilities of individuals with
disabilities.” (Assistive Technology Act of 1998)
The AT Team Includes:
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**The Individual**
Case Managers
Nurses
Occupational Therapists
Physical Therapists
Physicians
Psychologists
Speech Language Pathologists
Therapeutic Recreation Specialists
Vision Rehabilitation Specialists
…and many more!
AT Pyramid
High
Mid
Low
Developed at Pennsylvania’s Initiative on Assistive Technology
(Dolloff and Reinsfelder, 2010)
Examples of AT
• Low tech
– Pen and paper, Stylus, (Slim Jim or String Cheese?)
• Mid tech
– Pagers, Alarms, Simple vibrating watches
• High tech
– Automated systems / Reminders
– Smart phones and Tablets
– (Are these really “high tech” anymore?)
AT Services:
The Other Half
• Evaluation for appropriate devices and selection of
device.
• Coordination with service providers (e.g., therapists,
engineers).
• Training / technical assistance for the person and
supporting individuals (e.g., personal assistants).
• Follow up
HAAT Model
Cook and Hussey’s Assistive Technologies: Principles and Practice
HAAT Model
(Simplified)
• Human
• Activity
• Assistive Technology
AND
• Environment (context)
Time Management / Organization
• Low Tech
– Sticky notes
– Pre-organized books/folders
– Data planners
– Alarms / timers
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Computer based reminders
Online Tools
Paging systems / services
PDA's / Cell Phones
Time Management / Organization
Paper Calendar
iPhone
Talking Watch
Thought Organization
• Dragon Naturally Speaking
• Windows Speech Recognition
– (only available in Windows 7 and more recent
versions)
• WordQ / SpeakQ
• Word Prediction
Thought Organization
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Claro Read
DraftBuilder
Inspiration
Read and Write Gold
• Kurzweil 3000
• WYNN
• Mindview
Information Processing /
Comprehension
• Text to Speech
• Some magnification software programs also
highlight as they read
Speech to Text
Examples:
Captioned Telephone
www.captel.com
Real Time Captioning
Photo from:
http://webaim.org/technique
s/captions/realtime
Speech to Text
Example:
Google Voicemail Transcription
Photo taken from:
http://www.google.com/support/voice/bin/answer.py?answer=115986
Video:
http://www.youtube.com/watch?v=fHuai7-jVlY&feature=player_embedded
Memory
• Internet Calendars
– Color code and organize calendars and
appointments
– Can share with a caretaker using the same server
• Task lists
– Paper and pencil, or as an app
• Recording devices
• Zomm
Headsets for Concentration
ATH-ANC27
QuietPoint® Active
Noise-cancelling
Headphones
Microsoft LiveChat
Headset with
microphone
Communication
• Physical separate device dedicated to
communication
• Examples:
Dynavox EyeMax
Tobii ATI C12
Communication
• Using technology the person may already have
• Examples:
Proloquo 2 Go
NeoSpeech Paul or Kate
Vision
Apple Universal Access
Velcro
Photo taken from:
www.velcro.com
Bump Dots
Photo taken from:
www.maxiaids.com
Vision Examples
Copolillo A, Ivanoff SD. (2011) Assistive Technology and Home Modification
for People with Neurovisual Deficits. NeuroRehabilitation 28: 211-220. DOI
10.3233/NRE-2011-0650
• Neurovisual Deficits are different from progressive
eye diseases (macular degeneration, etc)
• Decreased control of eye movement, double vision,
sensitivity to light, decreased cognitive skills and
incorrect perception of the environment
• Correct balance between independence and safety.
Vision Examples (con’t)
Copolillo A, Ivanoff SD. (2011) Assistive Technology and Home Modification
for People with Neurovisual Deficits. NeuroRehabilitation 28: 211-220. DOI
10.3233/NRE-2011-0650
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Proper lighting in the home (incandescent)
Automatic lights (motion sensors)
Color filters
Contrast (furniture, rugs, walls, steps)
Magnifiers with lights or OCR
Read – along highlighting
Talking Clocks
Magnification and Audio
Victor Reader
Stream
Telesensory Desktop
CCTV
Assistive Listening
LES 370 Personal FM
System
Induction Loop ClipBoard
GPS Ranger
Noise Cancelling Headphones
LES705 Amplification system
Navigation Example
• Lemoncello, R., Moore Sohlberg, M., & Fickas, S. (2010). When directions
fail: Investigations of getting lost behavior in adults with acquired brain
injury. Brain Injury, 24 (3):550-559. Doi: 10.3109/02699050903446807
• 18 adults with acquired brain injury with 18
matched controls
• Problems: impulsivity, lack of planning,
memory lapses and anxiety
• Aids: written directions, standard cell phone
connected to a “helper”
Navigation Example (Con’t)
• Those with brain injury had more errors, and
used more vague descriptions of current
locations when calling for help.
• Cell phone was useful for reorientation and
reassurance
• Suggest navigational tools should also provide
reassurance to travelers they guide
Universal Design
Universal design is the design of products and
environments to be usable by all people, to the
greatest extent possible, without the need for
adaptation or specialized design.
–Ron Mace
http://www.ncsu.edu/www/ncsu/design/sod5/cud/about_ud/about_ud.htm
Examples:
– Audio descriptions
– Captioning
– Simplified interfaces
Video GPII
http://www.gpii.net/
Newer Opportunities for AT
Time Management & Organization
 Paging systems - software
– SMS – short message service
– MMS – multimedia messaging service
– Computer based
– Send messages to cell phone
– Google
Time Management & Organization
 General PDA's (soon to be outdated?)
– Windows
• Asus My Pal, Pharos, HP IPAQ
– MAC
• I-touch
 Smart Phones
– Windows, MAC, Android, Blackberry, Nokia
Symbian OS, Palm Web OS
Time Management & organization
 PDA’s / cell phones advantages
– Alert/Prompts – sound/vibration
– Search
– More information
– Information carries over – easier to change
– Link calendar + contacts
– Notes / To-Do’s
– Link to PC/Internet – 2 copies – synchronized
– Copy and paste from computer
Time Management & Organization
• PDA’s / cell phones advantages
– Looks “Normal” / the “cool factor”
– Basic models serve many cognitive needs
– PDA Software add-ons and Apps
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Dictionary
Spelling / Irregular Verbs
Word prediction
GPS
Cameras
Messaging
iPad / Samsung Galaxy Pad
Zoom / Streak / Playbook
E-readers
• E-Ink vs. Color screens
• E-readers with text to speech on some books
• E-readers with calendar feature
Examples of Evidence
Dowds MD, Lee PH, Sheer JB, O’Neil-Pirozzi TM, Xenopoulas-Oddsson A,
Goldstein R, Zainea KL, Glenn MB.(2011). Electronic Reminding Technology
Following Traumatic Brain Injury: Effects on Timely Task Completion. J Head
Trauma Rehabilitation. 1-9.
• 36 Adults with a Traumatic Brain Injury were
asked to complete tasks using 4 memory
strategies
• Those who used an electronic Personal Digital
Assistant (PDA) had a higher success rate of
completing the task over using paper and
pencil alone
Traumatic Brain Injury
May mean…..
Other things to consider
• Trauma can also affect other abilities
– Vision
– Hearing
– Balance
– Dexterity
Newer Technology
• Home monitoring systems
• “Face Time” can help to facilitate contact
• In development:
– Simplified digital scanners for warehouses
– Cell phones programmed with cognitive
assistance and encouragement – activated when
shaken
– “Context aware” devices
• Ex. Voice prompts activated when entering a room
Other Technology
• Signlink Studio - www.signlinkstudio.com
Wayfinding for Individuals with Dementia
Grierson, Lawrence E. M. , Zelek, John , Lam, Isabel , Black, Sandra E. and
Carnahan, Heather(2011) Application of a Tactile Way-Finding Device to
Facilitate Navigation in Persons With Dementia, Assistive Technology, 23:
2, 108 — 115
• A belt is worn
• Vibration cues occur in the direction the person
needs to go
• Found the design to be helpful
• Current design may not work in community settings
• Are there implications for people with TBI?
Key Things to Remember
• No two people are alike
• Each situation results in a unique solution,
application, or combination of tools
• Thinking outside of the box is good! 
• Include the individual in the process
• Avoid the temptation of trends
• Follow up, Follow up, Follow up!!
Three Key Points
• Description of the desired activity (goals)
• Individual’s history at it relates to the desired
activity (personal limitations)
• Environment the task will most likely take
place in (context)
Remember the HAAT?
Assistive Technology is
Creativity!
• No two individuals are the same
– What works for one service member may not
work for the others with similar barriers
• There is no “wrong way” to use tools
– If it was designed for one purpose but works to
accomplish another – great!
Resources
• State AT Act Programs
– www.ataporg.org
• Professional Organizations
– Ex. RESNA, ATIA
• Your team!
Contact Information
Amanda Reinsfelder, ATP
Amanda.reinsfelder@amedd.army.mil
202-257-5756