Patient-Centered Design of Cognitive Assistive Technology for Traumatic Brain Injury Telerehabilitation

Book description


Computer software has been productive in helping individuals with cognitive disabilities. Personalizing the user interface is an important strategy in designing software for these users, because of the barriers created by conventional user interfaces for the cognitively disabled. Cognitive assistive technology (CAT) has typically been used to provide help with everyday activities, outside of cognitive rehabilitation therapy.

This book describes a quarter century of computing R&D at the Institute for Cognitive Prosthetics, focusing on the needs of individuals with cognitive disabilities from brain injury. Models and methods from Human Computer Interaction (HCI) have been particularly valuable, initially in illuminating those needs. Subsequently HCI methods have expanded CAT to be powerful rehabilitation therapy tools, restoring some damaged cognitive abilities which have resisted conventional therapy.

Patient-Centered Design (PCD) emerged as a design methodology which incorporates both clinical and technical factors. PCD also takes advantage of the patient's ability to redesign and refine the user interface, and to achieve a very good fit between user and system.

Cognitive Prosthetics Telerehabilitation is a powerful therapy modality. Essential characteristics are delivering service to patients in their own home, having the patient's priority activities be the focus of therapy, using cognitive prosthetic software which applies Patient Centered Design, and videoconferencing with a workspace shared between therapist and patient.

Cognitive Prosthetics Telerehabilitation has a rich set of advantages for the many stakeholders involved with brain injury rehabilitation.

Table of contents

  1. Preface
  2. Acknowledgments
  3. List of Abbreviations
  4. Introduction
    1. 1.1 Origins of the Work
    2. 1.2 The Problem
    3. 1.3 A Successful Pilot Project
    4. 1.4 The Approach of the Institute for Cognitive Prosthetics
    5. 1.5 The Need for Cognitive Prosthetics
      1. 1.5.1 The Epidemiology of Cognitive Disabilities
    6. 1.6 Cognitive Dimensions Affecting the Design of Cognitive Assistive Technology
      1. 1.6.1 Acquired vs. Congenital
      2. 1.6.2 Degenerative vs. Non-Degenerative
      3. 1.6.3 Focal vs. Diffuse
      4. 1.6.4 Primary vs. Secondary (Complications of Medical Treatment)
      5. 1.6.5 Short-Term vs. Long-Term
    7. 1.7 Responding to the Need for Cognitive Assistive Technology
    8. 1.8 Cognitive Disabilities as a Unique Domain
      1. 1.8.1 Computer Software and Apps Providing Broad Cognitive Support
      2. 1.8.2 Working on Addressing Cognitive Disabilities During Revolutions in Computation and Neuroscience
      3. 1.8.3 Fascinating User Outcomes and Anomalies
    9. 1.9 Summary
    10. 1.10 Organization of the Book
  5. Some Clinical Features of the Cognitive Disabilities Domain with TBI Examples
    1. 2.1 Orientation of Medicine
    2. 2.2 Cognitive Deficits, Cognitive Disabilities, and Activities
    3. 2.3 Some Clinical Aspects of TBI
      1. 2.3.1 Damage from Traumatic Brain Injury
      2. 2.3.2 Rehabilitation
      3. 2.3.3 Cognitive Testing
    4. 2.4 A Guide to Cognitive Dimensions for the Computer Scientist
    5. 2.5 The Current Clinical Approach to Brain Structure and Functioning
      1. 2.5.1 Cognitive Neuroscience, Clinicians, and CAT
      2. 2.5.2 Implications of Cognitive Neuroscience for Cognitive Assistive Technology
    6. 2.6 Strategy for Dealing with Cognitive Constructs and TBI Cognitive Rehabilitation
    7. 2.7 Summary
  6. Adapting Computer Software to Address Cognitive Disabilities
    1. 3.1 Working with a Patient: An Example
      1. 3.1.1 UI Design Sessions (1/2)
      2. 3.1.1 UI Design Sessions (2/2)
      3. 3.1.2 Initial Results: Why the Checks for $0 Were not an Error
      4. 3.1.3 Epilogue
    2. 3.2 Summary
  7. The Primacy of the User Interface
    1. 4.1 Why the Typical UI is a Barrier to Computing Use by Individuals with Brain Injury
      1. 4.1.1 Interface Problems of Individuals with Cognitive Disabilities from Brain Injury
      2. 4.1.2 The Performance of the UI for Individuals with Cognitive Disabilities from Brain Injury
      3. 4.1.3 A Strategy for Using Software as a Cognitive Prosthesis
    2. 4.2 A Study in the Importance of Personalizing the UI for Cognitive Prosthetic Applications
      1. 4.2.1 Suedell
      2. 4.2.2 Roy
      3. 4.2.3 Sarah
      4. 4.2.4 Six Additional Subjects
      5. 4.2.5 Summary: The Importance of Personalizing the UI Study
    3. 4.3 Other Examples of the Importance of UI Design
      1. 4.3.1 Jerry
      2. 4.3.2 Eileen
    4. 4.4 The Contrasting Case of Reading Disability
      1. 4.4.1 Zack
    5. 4.5 Disproportionate Responses to Slight Changes in UIs for Brain Injury Users
    6. 4.6 Summary
  8. Patient-Centered Design
    1. 5.1 The PCD Model in the Context of Brain Injury
    2. 5.2 Case Studies
      1. 5.2.1 Case Study 1: Essence of Text Editor
      2. 5.2.2 Case Study 2: Patient and Therapist Contributions to Designing an Enhancement to Scheduling Software Application
      3. 5.2.3 Epilogue
    3. 5.3 Patient-Centered Design and the Design of a Cognitive Prosthetic Software Suite
    4. 5.4 Quality Improvement Studies Versus Medical Research
    5. 5.5 Summary
  9. Cognitive Prosthetics Telerehabilitation
    1. 6.1 The Cognitive Prosthetics Telerehabilitation (CPT) Model of Cognitive Assistive Technology
    2. 6.2 The Cognitive Load and Overhead Associated with Treating a Patient in the Clinic
    3. 6.3 The Advantages of CPT
      1. 6.3.1 The Availability of Specialized Brain Injury Rehab Services Wherever There Is Broadband Internet Service
      2. 6.3.2 The Advantages of Treating the Patient in their Own Setting with CPT
      3. 6.3.3 Therapy Sessions that Fit the Patient’s Abilities at the Moment: Flexible Length Sessions
      4. 6.3.4 A Different Cost and Revenue Structure for CPT Therapy
      5. 6.3.5 Continuity of Therapists along the Continuum of Care
      6. 6.3.6 Mobile Devices
    4. 6.4 Summary
  10. The Active User and the Engaged User
    1. 7.1 Patient Priority Activities as the Focus of Therapy
    2. 7.2 Early Priority Activities that are Linked to Upcoming Events in the Patient’s Life
    3. 7.3 Fast Achievement of Initial Intervention in Functional Rehabilitation
    4. 7.4 The Therapist’s Visit to the Patient’s Home
    5. 7.5 The Patient Designs the User Interface and Sees His/Her Ideas in the Software
    6. 7.6 During Sessions, the Patient Thinks, Talks, and Types, and the Therapist Thinks and Talks
    7. 7.7 The Patient Works on Short-Term-Goal Activities between Therapy Sessions
    8. 7.8 The Patient Generalizes the Use of Therapy Tools
    9. 7.9 The Patient Is Able to See Frequent Tangible Progress in Activities S/He Can Perform
    10. 7.10 The Therapist Asks For Software Features and Applications that Can Advance the Patient’s Progress
    11. 7.11 The Importance of the Active User and the Engaged User in Patient Rehabilitation Outcomes
    12. 7.12 Summary
  11. Patient Case Studies in the Use of Cognitive Assistive Technology: Successes and Failures
    1. 8.1  Case Studies
      1. 8.1.1 Melissa
      2. 8.1.2 Hugh
      3. 8.1.3 Jane
      4. 8.1.4 Dr. K
      5. 8.1.5 Dick
      6. 8.1.6 Leslie
      7. 8.1.7 Laura
    2. 8.2  Failures
      1. 8.2.1 Linda
      2. 8.2.2 Matt
      3. 8.2.3 Jack
      4. 8.2.4 Claudia
    3. 8.3  Summary
  12. Conclusions, Factors Influencing Outcomes, Anomalies, and Opportunities
    1. 9.1  Conclusions
      1. 9.1.1 The User Interface Is the Most Sensitive Design Element in Applications for Individuals with Cognitive Disabilities from Brain Injury
      2. 9.1.2 Cognitive Assistive Technology as a Valuable Therapy Tool for Brain Injury Cognitive Rehabilitation
      3. 9.1.3 Patient-Centered Design as an Important Design Methodology when Clinical Issues are a Factor in the Design of CAT
      4. 9.1.4 The Ability of the Brain Injury Patient to Play the Key Role in Designing His/Her UI, which Will Be Intuitive to that User
      5. 9.1.5 Cognitive Prosthetics Telerehabilitation is a CAT and a Modality of Cognitive Rehabilitation Therapy
    2. 9.2  Factors Influencing Outcomes
      1. 9.2.1 The Therapist and Technology are Both Essential Parts of the CPT Modality
      2. 9.2.2 “Pressing the Patient’s Buttons”
      3. 9.2.3 The Ability to Support a Broad Range of Patient Priority Activities
      4. 9.2.4 The Active User and the Engaged User
      5. 9.2.5 Therapist’s Use of Patient Work-Product Data
      6. 9.2.6 The Ability to Support the Patient in the Settings where they Plan their Activities
      7. 9.2.7 Likely Mechanisms
    3. 9.3  Anomalies in Patient Behavior
      1. 9.3.1 The Substantial Abilities of Individuals with Profound and Severe Disabilities
      2. 9.3.2 The Limitation of “High Functioning” Individuals
      3. 9.3.3 Island of Abilities in Seas of Deficits (IASODs)
      4. 9.3.4 Islands of Deficits in Seas of Abilities (IDSOAs)
      5. 9.3.5 Patient Creativity in Developing Functionality in Software
      6. 9.3.6 When Hard Is Easy and Easy Is Hard
      7. 9.3.7 “Out-of-Sequence” Rehabilitation
      8. 9.3.8 Other Instances of Anomalies in Behavior
    4. 9.4  Opportunities
      1. 9.4.1 Exploring Patient-Centered Design
      2. 9.4.2 Methodological Issues
      3. 9.4.3 Measurement for CPT
      4. 9.4.4 Implications for Robotics and the Active and Engaged User
      5. 9.4.5 Errorless Learning Strategies, Cognitive Prosthetics, and Efficient Delivery of Cognitive Support Services
      6. 9.4.6 New Opportunities for CAT Presented by Advances in Cognitive Neuroscience
      7. 9.4.7 Developing Clinical Services
    5. 9.5  Summary
  13. Bibliography (1/2)
  14. Bibliography (2/2)
  15. Author Biography

Product information

  • Title: Patient-Centered Design of Cognitive Assistive Technology for Traumatic Brain Injury Telerehabilitation
  • Author(s): Elliot Cole
  • Release date: March 2013
  • Publisher(s): Morgan & Claypool Publishers
  • ISBN: 9781608456444