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]
Grant Number H133A030810
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
Grant Number H133A030810
Research Phases:
1- Alarm Response Studies
2- Extended PDA Training Sessions
3- Smartphone Studies
Grant Number H133A030810
Phase 1
Alarm Response Studies
Grant Number H133A030810
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?
Grant Number H133A030810
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.
Grant Number H133A030810
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 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
Grant Number H133A030810
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
Grant Number H133A030810
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
Grant Number H133A030810
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
Grant Number H133A030810
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
Grant Number H133A030810
School-Age
Alarm Response Results
Grant Number H133A030810
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)
Grant Number H133A030810
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%
Grant Number H133A030810
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)
Grant Number H133A030810
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)
Grant Number H133A030810
Case Studies: Phase 1
Grant Number H133A030810
Subject Description: RW
Female
Age: 19
Sustained TBI in car crash
School Placement: Educ. Services through a county MRDD program
Device: Palm
Grant Number H133A030810
RW - Video
Grant Number H133A030810
RW: Alarm Response Studies Results
0-33-TBI Age 18
012345678
tasks
calls
Grant Number H133A030810
Subject Description: MB
Male
Age 14
Intellectual Disability
Special education classroom/middle school
Limited literacy skills; good verbal skills
Dell Pocket PC
Grant Number H133A030810
MB: Alarm Response Studies Results
023-ID
012345678
TaskCall
Grant Number H133A030810
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.
Grant Number H133A030810
Phase 2
Extended PDA Training Sessions
Grant Number H133A030810
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
Grant Number H133A030810
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
Grant Number H133A030810
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
Grant Number H133A030810
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
Grant Number H133A030810
Case Studies: Phase 2
Grant Number H133A030810
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
Grant Number H133A030810
RW – Task List Video
Grant Number H133A030810
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:
Grant Number H133A030810
MB- Dell Calendar Video
Grant Number H133A030810
MB Teaches Another Student to Use the Dell Video
Grant Number H133A030810
PDA to Smart Phones a Logical Next Step for Universal Access/Design
Grant Number H133A030810
Phase 3
Smartphone Studies
Grant Number H133A030810
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
Grant Number H133A030810
Case Studies: Phase 3
Grant Number H133A030810
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
Grant Number H133A030810
RW – Cell Contacts Video
Grant Number H133A030810
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
Grant Number H133A030810
MB – Cell Contacts Video
Grant Number H133A030810
MB – Cell Picture Video
Grant Number H133A030810
MB – Cell Text Message Video
Grant Number H133A030810
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
Grant Number H133A030810
“It’s changed my life…”
Grant Number H133A030810
“What I Really Like…”
Grant Number H133A030810
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
Grant Number H133A030810
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?)
Grant Number H133A030810
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
Grant Number H133A030810
For more information…
Wild, M. and Schwartz, S. H. (2008). Memory Compensation Using the Pocket PC. Laguna Hills, CA: ID 4 the Web.
Grant Number H133A030810
AP & “Frank” - Video
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