PDAs and Cognitive-Communicative Disability ________________________________________________

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• PDAs and Cognitive-Communicative Disability
  ________________________________________________
• The University of Akron
• School of Speech-Language Pathology and Audiology
• Yvonne Gillette, yg_at_uakron.edu
• Roberta DePompei, rdepom1_at_uakron.edu

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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 (PDAs)
• Inform consumers and other stakeholders as they
  make technology decisions

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Research Phases

• 1- Alarm Response Studies
• 2- Extended PDA Training Sessions
• 3- Smartphone Studies

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Phase 1

• Alarm Response Studies

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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?

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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.

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Mean Rate of Responding Across Condition
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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

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Key Findings for Adults with TBI

• Participants
• Performed best with PDA
• Performed better with PDA than simple list
• Showed no difference between phone call and daily
  task
• Performed better with Palm than Dell
• Gender, age, and cognitive test performance
  levels were not predictive

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Key Findings for Students with ID or TBI

• Participants
• Performed best with PDA
• Performed better with PDA than simple list
• Showed no difference between phone call and daily
  task
• Had 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

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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

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• School-Age
• Alarm Response Results

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School-Age Results Alarm Response Studies

• Student performed best with the PDA compared to
• Simple list of times and tasks (plt.024)
• Weekly Appt. Book (plt.002)

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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

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School-Age Studies Exit Survey, Summary of
Student Comments

• Both (2)
• No response (1)
• Games (4)
• Paper (2)
• Dell (2)

• Preferred device
• Palm (18)
• Dell (11)
• Preferred function
• Camera (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 school
• It was fun to play with
• Student who chose alarms said
• I can set alarms for myself

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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)

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Case Studies Phase 1
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Subject Description RW

• Female
• Age 19
• Sustained TBI in car crash
• School Placement Educ. Services through a county
  MRDD program
• Device Palm

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RW - Video
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RW Alarm Response Studies Results
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Subject Description MB

• Male
• Age 14
• Intellectual Disability
• Special education classroom/middle school
• Limited literacy skills good verbal skills
• Dell Pocket PC

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MB Alarm Response Studies Results
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Summary of Significant Findings
RW MB
1. Great difference between electronic and paper 1. 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.
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Phase 2

• Extended PDA Training Sessions

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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

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Group ResultsExtended 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 Post
• Calendar
• Responding to alarms 4 6
• Setting alarms 3 6
• Accessing data 4 6
• Entering data 3 3
• Contact List
• Accessing data 3 5
• Entering data 3 4
• Task List
• Accessing data 3 5
• Entering data 2 4

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Group ResultsExtended PDA Training Sessions
Functions and Features (cont.)

• Pre Post
• Calculator 4 6
• Notes
• Text 1 4
• Voice 2 6
• Games
• Jawbreaker 1 2
• Solitaire 1 1
• Tetris 0 4
• Beaming 0 4

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Group ResultsExtended PDA Training Sessions
Functions and Features (cont.)

• Pre Post
• Computer Functions
• Hot sync 1 3
• File upload 0 3
• Microsoft Office
• Word 0 1
• Excel 0 1
• Camera Functions
• With camera function 2 2
• Without camera function 4 4
• Personalization Features
• Ring tones 0 0
• Font changes 0 2
• Screen settings 1 3
• Background 0 1

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Case Studies Phase 2
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RW Extended PDA Training Sessions Palm
Functions Used

• Used pre and post training
• Calendar
• Responding to alarms
• Setting alarms
• Accessing data
• Contact List
• Accessing data
• Entering data
• Task List
• Accessing data
• Calculator
• Games
• Solitaire
• Camera
• Computer Functions
• Hot sync

• New Functions
• Task List
• Entering data
• Notes
• Text
• Voice
• Games
• Tetris
• Beaming
• Computer Functions
• File upload
• Did not use pre or post
• MS Office
• Personalization options

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RW Task List Video
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MB Extended PDA Training Sessions Dell
Functions Used

• Used pre and post training
• Calendar
• Responding to alarms
• Games
• Jawbreaker
• Task List
• Computer Functions
• MS Office
• Personalization options

• New Functions
• Calendar
• Setting alarms
• Accessing data
• Contact List
• Accessing data
• Notes
• Text
• Voice
• Calculator
• Games
• Tetris
• Beaming

Did not use pre or post
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MB- Dell Calendar Video
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MB Teaches Another Student to Use the Dell Video
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PDA to Smart Phones a Logical Next Step for
Universal Access/Design
Everybody's Gotta Have One!
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Phase 3

• Smartphone Studies

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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

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Case Studies Phase 3
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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 data
• Games
• Jawbreaker
• New features used
• Ring tones
• Screen settings
• Background

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RW Cell Contacts Video
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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 tones
• Background

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MB Cell Contacts Video
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MB Cell Picture Video
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MB Cell Text Message Video
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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

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Its changed my life
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What I Really Like
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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 acceptable
• Prices 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

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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?)

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Future Recommendations

• Hold joint meetings of researchers/manufacturers
  vendors.
• Consider the consumer base as much larger
• Value and fund empirically based studies
• BUTLook 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 good
• Disseminate to clinicians/teachers/support people
  who can make a difference on a daily basis
• Inform policy makers/third party payers

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For more information

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

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AP Frank - Video