PDAs and Cognitive-Communicative Disability ________________________________________________

Grant Number H133A030810

PDAs and Cognitive-Communicative Disability

________________________________________________The University of Akron

School of Speech-Language Pathology and AudiologyYvonne Gillette, [email protected]

Roberta DePompei, [email protected]

mailto:[email protected]

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Purpose of the Project

• Compare the effectiveness of electronic prompting technology as opposed to simple lists and paper calendars.

• Explore electronic organizers re: cognitive disabilities in memory and organization

• Conduct usage trials in naturalistic environments of school or home.

• Determine customization of devices that meet the needs of students with cognitive disabilities.

• Present findings to other researchers as well as developers of personal data assistants (PDA’s)

• Inform consumers and other stakeholders as they make technology decisions



Research Phases:

1- Alarm Response Studies

2- Extended PDA Training Sessions

3- Smartphone Studies



Phase 1

Alarm Response Studies



Research Questions for Alarm Response Studies

Do differences in “on-time” behavior occur when comparing performance with PDAs (personal data assistants) to calendars in daily planners or simple list (did condition make a difference?)

Do differences in “on-time” behavior occur when subjects receive an a.m. reminder “to use their reminder system” vs. no a.m. reminder (Did period make a difference?)

Do other factors, such as educational placement, age, diagnosis, contribute to the outcomes?



Research Design- Phase 1 (Alarm Response Studies)

Subjects: SA-ID/TBI (Akron), A-TBI (Spaulding), A-ID (Temple)

Method: 8 week in vivo trials with two periods, each with a baseline condition and three additional randomized conditions

Conditions: (1) Simple list: reminder-list of times for tasks and calls by week (baseline) (2) Paper/calendar: subject reminder- an “At-A-Glance” weekly reminder (3)&(4) PDA: subjects reminder-a Palm Zire one week, a Dell Axim

Periods: Period 1: weeks 1-4 which included one a.m. reminder of the need to call or

do a task Period 2: weeks 5-8 which did not include any reminders

*Typically, this provided 8 opportunities per week, but the ratio allows for absences that might occur during the week.



Mean Rate of Responding Across Condition Mean Rate of Responding Across Condition (Baseline, Planner, Dell, Palm)

0

10

20

30

40

50

60

70

80

90

100

SA-ID/TBI

A-TBI A-ID SA-ID/TBI



A-TBI A-ID

Baseline Planner Dell Palm

Condition by Population

Mea

n R

ate

of R

espo

ndin

g

Weeks 1-4Weeks 5-8


Key Findings for Rate of Responding:

Palm PDA was the most effective reminder method across groups

School-age TBI/ID site had greatest mean rate of response across sites and conditions with Palm Adult TBI site had next highest rate with Palm

Planner was the least effective Reminder systems were most effective with school-age

TBI/ID and adult TBI sites


Key Findings for Adults with TBI:

Participants:Performed best with PDAPerformed better with PDA than simple listShowed no difference between phone call and daily taskPerformed better with Palm than Dell

Gender, age, and cognitive test performance levels were not predictive


Key Findings for Students with ID or TBI:

Participants:Performed best with PDAPerformed better with PDA than simple listShowed no difference between phone call and daily taskHad similar performance with Dell and Palm Performed 15% better in least restrictive environment Were 50% better with an A.M. reminder

Gender, age, diagnosis, and cognitive test performance levels were not predictive


Key findings for adults with ID:

More independence with electronic Relieved caregiver burden Performed best with A.M. reminder Better performance in non-sheltered workshops due to more

environmental opportunities


School-Age

Alarm Response Results


School-Age Results: Alarm Response Studies

Student performed best with the PDA compared to:

Simple list of times and tasks (p<.024)

Weekly Appt. Book (p<.002)


School-Age Results: Alarm Response Studies

Students performed 50% better with one, daily morning reminder to “remember your appts.”

Students placed in less restrictive environments performed better than those in a more restrictive environment by 15%


School-Age Studies Exit Survey, Summary of Student Comments

Preferred devicePalm (18)Dell (11)

Preferred functionCamera (7)Volume (6)

Did device help with completion of task?Yes (32)No (0)All of them (1)

Which device helped most?Electronic/both (14) Palm (9)

Student who chose camera said:It helped in schoolIt was fun to play with

Student who chose alarms said: I can set alarms for myself

Both (2) No response (1)

Games (4)

Paper (2) Dell (2)



School-Age Studies Exit Survey, cont.

Student who said calendar said:The organizer helped me remember

The organizer helped me remember

Student who said audio recorder said:I liked to record music at home

Did you try some other functions? Yes (22) No response (3)

What functions were those? Games (12)Camera (11)

tell us about your experience Fun/really liked participating in study (15)No (3)

No (6 )N/A (1)

Calculator (4)Address book (4)

The gift card (2)Learned something (2)



Case Studies: Phase 1



Subject Description: RW

Female

Age: 19

Sustained TBI in car crash

School Placement: Educ. Services through a county MRDD program

Device: Palm



RW - Video


RW: Alarm Response Studies Results

0-33-TBI Age 18

012345678

tasks

calls



Subject Description: MB

Male

Age 14

Intellectual Disability

Special education classroom/middle school

Limited literacy skills; good verbal skills

Dell Pocket PC



MB: Alarm Response Studies Results

023-ID

012345678

TaskCall



Summary of Significant Findings*

RW MB1. Great difference between

electronic and paper1. Consistency throughout weeks

2. Best results with the Palm 2. Some improvement across all areas, but best results with Palm

*Refer to previous Alarm Response Studies tables.


Phase 2

Extended PDA Training Sessions



Research Design - Phase 2 (Extended PDA Training Sessions)

Subjects: 6 school-age individuals, recruited from Phase 1 study

Method: 7 one-on-one training sessions conducted in weekly intervals with student and graduate student researcher, with consistent supervision and modeling as needed from teacher and family member

Conditions: (1) Commitment of family member and teacher (2) Incorporation of school assignments in the use of the

device (3) Subjects used the same PDA: Palm Zire or a Dell Axim



Group Results:Extended PDA Training Sessions: Functions and Features

Note: Of the six participants, 2 used Palm and 4 used Dell. This accounts for some variation in the functions of the devices.

Pre PostCalendar

Responding to alarms 4 6Setting alarms 3 6

Accessing data 4 6Entering data 3 3

Contact ListAccessing data 3 5Entering data 3 4

Task ListAccessing data 3 5Entering data 2 4


Group Results:Extended PDA Training Sessions: Functions and Features (cont.)

Pre PostCalculator 4 6Notes

Text 1 4Voice 2 6

GamesJawbreaker 1 2Solitaire 1 1Tetris 0 4

Beaming 0 4


Group Results:Extended PDA Training Sessions: Functions and Features (cont.)

Pre PostComputer Functions

Hot sync 1 3File upload 0 3Microsoft Office

Word 0 1 Excel 0 1

Camera FunctionsWith camera function 2 2Without camera function 4 4

Personalization FeaturesRing tones 0 0Font changes 0 2Screen settings 1 3Background 0 1


RW: Extended PDA Training Sessions – Palm Functions Used

Used pre and post training:Calendar

Responding to alarmsSetting alarmsAccessing data

Contact ListAccessing dataEntering data

Task ListAccessing data

CalculatorGames

Solitaire CameraComputer Functions

Hot sync

New Functions:Task List

Entering dataNotes

Text Voice

GamesTetris

BeamingComputer Functions

File upload

Did not use pre or post:MS Office Personalization options


RW – Task List Video


MB: Extended PDA Training Sessions – Dell Functions Used

Used pre and post training:Calendar

Responding to alarmsGames

Jawbreaker

Task ListComputer FunctionsMS OfficePersonalization options

New Functions:Calendar

Setting alarmsAccessing data

Contact ListAccessing data

NotesText Voice

CalculatorGames

TetrisBeaming

Did not use pre or post:


MB- Dell Calendar Video



MB Teaches Another Student to Use the Dell Video


PDA to Smart Phones a Logical Next Step for Universal Access/Design


Phase 3

Smartphone Studies



Research Design - Phase 3 (Smartphone Studies)

Subjects: 2 school-age individuals, recruited from Phase 2 study

Method: 7 one-on-one training sessions conducted in weekly intervals with student and graduate student researcher, with consistent supervision and modeling as needed from teacher and family member

Conditions: (1) Commitment of family member and teacher (2) Incorporation of school assignments in the use of the

device (3) Subjects used Nokia Smartphones



RW Phase 3– Smartphone Functions Used: Nokia 6682 for 4 weeks, then switched to model 6170

Additional functions used at end of phase 3:Calendar

Entering dataGames

Jawbreaker

New features used:Ring tonesScreen settingsBackground


RW – Cell Contacts Video


MB Phase 3 – Smartphone Functions Used: Nokia 6682

Additional functions used at end of phase 3:Calendar

Entering data (with written prompts)Contact List

Entering data (with written prompts)Task List

Accessing data Camera

New features used:Ring tonesBackground


MB – Cell Contacts Video



MB – Cell Picture Video



MB – Cell Text Message Video



PDA Intervention Plan

Implements electronic memory and organization aids:Assesses the need for PDA intervention Uses a 1-7 point rating scale Covers a variety of functions

Develops an intervention plan Considers environments, partners, outcomes, etc.

Monitors progress Reports by support person and client


“It’s changed my life…”


“What I Really Like…”


What Have We Learned? Electronic aids are useful for some persons with

memory/organization problems as a result of cognitive challenges. Evidence based studies are emerging to support use. Generic devices may be most accessible and useful There are functions/features of generic devices that might need to

be altered to facilitate usability/universal access. Generic devices have appeal because

Socially more acceptablePrices are lower than “dedicated devices”General public understands use more easily

Barriers: Cost, Perceived Lack of Need, Lack of Training and Supports, Lack of Accessibility in Design Features



What is Not Known? Who within the population can benefit? Is there a larger base to consider? What factors besides the cognitive deficits are

significant? What makes technology accessible? What supports will help? What functions/features can help facilitate learning if

modified? How can third party payers be influenced to pay for

generic devices and their modifications? (Ex: Any payer willing to support smart phone monthly charges?)



Future Recommendations Hold joint meetings of researchers/manufacturers

vendors. Consider the consumer base as much larger Value and fund empirically based studies

BUT—Look to in vivo trials-real people in natural environments over longer periods of time- to provide information that can inform manufacturers, vendors, and policy makers.

Advocate where it will do the most goodDisseminate to clinicians/teachers/support people who can make a difference on a daily basisInform policy makers/third party payers



For more information…

Wild, M. and Schwartz, S. H. (2008). Memory Compensation Using the Pocket PC. Laguna Hills, CA: ID 4 the Web.


AP & “Frank” - Video


PDAs and Cognitive-Communicative Disability ________________________________________________

Documents

Transcript of PDAs and Cognitive-Communicative Disability ________________________________________________