smart technology - gentry - compressed

7/31/2019 Smart Technology - Gentry - Compressed

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Typical cognitive problems Memory for names/faces, locales Task Sequencing Multi-tasking Dealing with Distractions Remembering to do things (medications,

appointments) Adapting to transitions and changes in routines Dealing with frustration

How These Deficits Affect Us Remembering to do things (medications, appointments)

Memory for names/faces, locales

Task Sequencing

Multi-tasking

Dealing with Distractions

Adapting to transitions and changes in routines

Dealing with frustration

Processing and managing communication

Self-awareness and insight

Judgment and social skills

How these Affect Our Lives Inconsistent medication:

Hospitalization, decline in health

Missing appointments:

costs money, jobs and friends

Missing bills:

Eviction from your home, bill collectors

Self-awareness, judgment difficulties:

Getting lost, traffic accidents, social problems

Task-Sequencing Problems:

Job failure, need for supervision

Problems multi-tasking or dealing with distractions:

Home and community safety, difficulty at work

Low-Tech Cognitive Aids

Behavioral ChallengesSpeech-CommunicationInterpreting Non-Verbal CommunicationFrustration ToleranceStimming/Unusual BehaviorsMental Health issuesLack of familiarity with appropriate social behaviors in work settingDealing with customers/co-workersSensorimotor comorbidities

People with cognitive-behavioral

challenges least likely group to

use ATPeople with autism may prefer

computer interaction to human

cueingSmall AT strategies can be life-

changersTechnology is changing rapidlyConsumer-based products are

especially robust


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School-based AT Transition Issues:AT does not follow the person

AT not portable for work settingsAT outdated

AT is disability-identifiedChange in life roles

AT as primary support vs. AT as adjunctWhat can we do?

Functional Cognition Assessment

Canadian Occupational Performance Measure

(COPM)

Rivermead Behavioral Memory Test - Extended

(RBMT-E)

Test of Everyday Attention (TEA)

Multiple Errands Test (MET)

Vectoring

Reports of MD, neuropsychologist, teachers andtherapists

Formalized assessment tools

Interview with client and family

At home observation during everyday tasks

Interest inventory

Estimation and confirmation

Does this nail fit your hammer?

Expectation of fluctuation

Crucial Questions:

Safety at home and in the community

Kitchen, bathroom, doors & windows

Food safety

Street smarts

Geographic orientation skills

Calling for help

Managing frustration

Crucial Questions:

Medication Management

Diet & Dining

Driving

Managing Finances/Bills

Personal Supports

Potential for school or work

Non-cognitive disability

issues


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Crucial Questions:

Other daily livingactivities

What do you mostwant to do?

What solutions haveyou tried?

What seems to beworking?

Role of caregiver

Insight & Motivation

Time Trial & Error

Attention

Self-Awareness

Goals

Self-Efficacy

Person

Task

Place

21st Century Rehabilitation

Remembering to do things/forward planning Task-Sequencing Wayfinding Managing Problematic Behaviors & Situations Health Management Safety Communication Home & Money Management Academics Sensory ability accommodations

How ATC Can Help:

Tony Gentry, PhD OTR/LAssistant ProfessorDepartment of Occupational TherapyDirector, Assistive Technology for Cognition Laboratory

Virginia Commonwealth [email protected]


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Practical, portable tools

Tony Gentry, PhD OTR/LDepartment of Occupational Therapy


Cognitive Rehabilitation

Emerged anddeveloped alongsidepersonal computing

Remedial vs.CompensatoryApproaches

1980s

Dawn of CognitiveRehabilitation

Personalcomputers

1990s

Calls for ecologicallyvalid research

Desktop computers asreminder systems andtask-sequencingcoaches

Where weve been. Portable Computer ResearchPsion Organizer

NeuroPage

Cell phones

PDAs

Disability-specific

Software for PDA


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2000s

Handheld compensatory

solutions

Distributed-cognitionexperiments

Collaborative Contextualapproach

Traditional ATC Roles

Reminder systems Alarm reminders linked to calendars

Pagers

Digital tape recorders

Task-Sequencing Prompts

Multi-media options

Plain Old Cell Phone

Carry it everywhereSpeed Dial for FrequentCallsText-MessagingCalendar RemindersContact informationCamera

Varied features by phone

Onboard tools (all PDAs)Calendar with reminder alarm prompts

To Do ListAudio Recorder

Notes to Self programContacts/Address List

Alarm ClockPhoto Album

Video-PlaybackTap-learning screen

What can a PDA HelpWith?Scheduling/Reminders

Time Management

Task Sequencing

Way-Finding

Behavioral Cues

Education

Video chat with job coach

And more.

Smartphones

Apple iphoneSamsungGalaxy Note

Nokia Lumia900


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Ipod Touch 4 Front-rear facing still and

video camera

Face Time video-calls

Built-in microphone Voice-over accessibility Background-running

program capability Application Folders Games interactivity

Apple Ipad(s) Large icons for dexterity-challenged

Louder speaker for augmentative communication

Larger screen

iPadsGenerations

Offmarket

$399

$499

Accessibility Reads any text onscreen Zooms by touch Mono Audio Gesture simulator All toggled by home button

(3x click) New iPad allows dictated

emails, notes, etc.

Android Tablets Samsung Galaxy

Motorola Xoom

Dell Streak

Many others

Windows(7(Tablets(

Acer(Iconia(Tab(

Asus(eee(

$350:500(


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iPad Killers?

Barnes & Noble

Tablet Nookrunning AndroidHoneycomb($199)

Kindle Firerunning AndroidGingerbread($199)

Whats missing Phone/ipod have weak

speakers Poor visibility in bright

daylight Haptic touch USB port for access

switches Apps not optimized for

Bluetooth switch access See article

For Less than $100US

People who only need remindersPeople with more severe

impairments who do not havecaregivers to help program andmaintain more complex tools

Medication Reminders Pill Dispenser Alarm Pulse rate Blood pressure

www.epill.com

Audio Recorders Digitally record reminder

alarms

Tapes can playback atvarying speeds

Good for note-taking Generally easy to use

Various manufacturers

www.ohdontforget.com Free web-based text

message remindersystem for cell phones

No repeated reminders Text message charge

from provider Can be programmed in

anywhere the web isavailable


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Google Calendar > Cellphone

Text message acalendar reminder

Can be used on anycell phone that allowstexting

Legacy Tools

Tony's Old PDAWebsite

Person LocatorsInstamapper (free)Four Square (free)Most smartphonesBest with unlimited

data plans

GPS:Based(Person(Trackers(

Spark&Nano&

Brickhousesecurity.com(

Nu-M8Lok8u.com

Aetrex.com

Lifesaver.orgSmart Home/Office Safety Task Management Environmental

Control Communication Comfort See article


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AT for Cognition on PDA Remembering to do

Things Task-Sequencing Behavioral Adaptation Way-finding Communication Health Management

Tony Gentry, PhD OTR/LAssistant ProfessorDepartment of Occupational TherapyDirector, Assistive Technology for Cognition LaboratoryVirginia Commonwealth [email protected]


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Prospective Memory &

Task PlanningTony Gentry, PhD OTR/LDepartment of Occupational Therapy


Time Management

Before After

ATC at home/worksite Typical reminders Medications Wake up Catch bus Clock in at work Breaktime (with timer) Lunch (with timer) Switch from one task to

another Clock out and go home Plug in device to charge

overnight

Reminders app Reminder Add-on Apps

Due Tell MeLater


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Two New Reminder Apps

BugMe!

VoCalBugMe!

Time Timer

for work speed, attention to task, etc.

Time%Timer%Custom%Se-ng% Medication Management

Pillboxie Medsy

Medication Reminders Pill Dispenser Alarm Pulse rate Blood pressure

www.epill.com

Remember to do things &

Switch Tasks Calendar reminders

Easy to view in list view Share across devices/pcs

Reminders (iOS 5) Task list + reminder

Clock reminders Variable sound alerts Countdown timer Not available on ipad

Explore Calendar Reminders: Enter a reminder for 5:00 pm (Go

home!) Explore Reminders app Explore Clock Reminders (ipod

touch only) Choose a sound Enter a reminder for 10 minutes from

now Try out a countdown timer (for 5

minutes from now)


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0

5

10

15

20

25

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Series1Series2Series3

In Assessment Can your client set her/his own alarm reminders? Can an employer or family caregiver set alarm

reminders? Most importantly: Can your client hear/read the alarm? When the alarm goes off, does your client respond

to it? Does your client do what the alert says to do? Does your client safely stow device during task?

In Training: Find out what tasks and activities typically require

someone to nag your client to get done. These can beat home or at work.

Prioritize these in order of: (1) safety, (2) on timeperformance, (3) task switching needs

First week, set no more than 5-6 reminders for each day Check in to see if client is responding appropriately and

consistently to reminders If not, consider: (1) different app, (2) reward system, (3)

speaker for device or move it closer (armband?), (4) whatelse?

Vary, increase, adapt as needed to provide just-in-timesuite of reminders for daily activities.

In Training Onboard apps allow setting an alarm reminder that cues

you to open a Note with a to do list on it or a task-sequencing video.

Make sure the To Do list app you choose is on front pageor in Work folder in Tray.

Consider using Note taking apps like these to recordinspirational or behavioral prompt messages as well.

As with reminder alarms, does your client use the Note orTo Do list successfully and independently to get workdone?

If not, what might work better?

Tony Gentry, PhD OTR/LAssistant ProfessorDepartment of Occupational TherapyDirector, Assistive Technology for Cognition Laboratory



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Strategies for Task-Sequencing, Wayfindingand Behavioral CueingTony Gentry, PhD OTR/LDepartment of Occupational Therapy


More mobile AT Task-Sequence Behavioral Cueing Wayfinding Social Stories

Ipod Touch 4g and iPad 2/new Front-rear facing still and

video camera Face Time video-calls Built-in microphone Voice-over accessibility Background-running

program capability Application Folders Games interactivity

Visules Select a Work-related

5-step Task List Take close-up pix for

each step Build task sequence in

Visules

HomeRoutine Create a timed task

routine for your ownSaturday morning thisweek

http://www.homeroutines.com/using-homeroutines/using-routines/

Can you set a timer foryour routine?

First-Then


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Task-Sequencing Powerpoint Take photos ofsequence Create powerpoint

with typed prompts Save as movie (Office

2010) Export to pda

HackStory Kit Free app Picture sequences Captioning and drawing Audio cues http://www.youtube.com/

watch?v=RSWQkUS4kXk

Video Modeling Most well-researched of

all AT for cognitionapproaches

Rehearse Play and Pause Review See handout

Task-Sequencing Apps Going Places http://

www.modelmekids.com/iphone-app-autism.html

6 locations FREE on App Store

Everyday Skills

Ablelink App 40 activities $39.99

Task-Sequencing Video Best is to show client

performing tasksuccessfully

Can use during task Also pre- post-task for

rehearsal/review


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Wayfinding Works better

than GPS formany people

GPS requiressatellite access(and phoneplan)

Behavioral Prompts 32-year old woman Group home Autism and Severe

OCD Compulsively calls

mom for advice up to6 hours/day

Behavioral Prompts 19 year old with

Autism Medical Supply

aide at hospital What to do

when people

bother you.

iPod Touch 4g, Ipads 2/new Simplified iMovie allows

improved editing directlyon device

http://www.youtube.com/watch?v=MEaWuCrI24s&feature=relmfu

Picture Scheduler Open App Create a reminder

prompt for 5 minutesfrom now

Click to add picture Click to select a video

Mini-Cams User friendly software Software onboard

camera, loads on pc Straightforward editing Not so straightforward

transfer to Kindle andNook Color


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How much do you need? Text Note Add picture Picture

sequence Add audio Video Reminder? Think forward

and reverse

Video Lab Teams of 3 Read your case study Storyboard a task

sequence or behavioralprompt

Videotape on ipod 4g oriPad 2

Edit

When shooting: Keep it short Bright light Close ups Try to get it right the

first time Narrate concisely as

you go Give it a useful title

We will share and vote!



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Apps for Cognitive-Behavioral, Sensory &Communication ChallengesTony Gentry, PhD OTR/LDepartment of Occupational Therapy


Accessibility Features Go to Utilities Settings Accessibility Toggle on/off with 3

taps on bottom button Turn off access

features

Apps that Help

Person-locator Seizure tracker Free cellphone access Cognitive challenge games Behavior trackers/cues Augmentative Communication Apps for Sensory issues Four-Square

Find My Iphone Must have Mobile Me

account with Apple Must set up App on

device you want to locateand another device (pc ormobile device)

Can see on map Can send a note Can lock or wipe device

Seizure Trackerwww.epdetect.com

Windows mobile

www.epilepsy.comFor Iphone or pc

Real-time help

FaceTime (Apple iOSonly)

Plain old phone


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Cellphone on your PDA Skype (free) Line 2 (9.95/month) Fring (free) Facetime (touch to

touch)

Health Folder

Sleep Hygiene Zeo ($149) with pc-

based sleep coach

Sleep Cycle ($.99)

Behavioral Apps iCounselor OCD Anxiety Fear Depression (each is $.99)

DoD#app#for#anxiety# Mood Tracker Pro Veterans Affairs-

developed Shows graph of mood

changes over time Can link to reminder for

periodic check-ins Share with clinician


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Behavior Trackers Behavior Tracker Pro Skill Tracker Pro Each $29.99 on App

Store

Relaxa0on#Apps#

Music FolderLearning the interface with Games

Bubble Popper screen tapping Labyrinth LE using accelerometer feature Game Center games social interaction

Simple Money ManagementExpenses

1.99

Classwork Planning


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Augmentative Communication Confer with SLP to determine the right app for your

child Confer with OT for device adaptations Sometimes an AAC hardware will work better Consider school legacy tools

Free-standingdevices DynaVox Tobii Go Talk Etc.

Proloquo2go

On Apple App Store $190 www.proloquo2go.com

Voice4Youwww.voice4uaac.

comIphone, ipad

$29.95

Speak it!

$1.99On ITunes

www.taptotalk.comTap to Talk Designer

$99.95/year

Free AppRuns on Nintendo

DS, ipod touch,

iphone, ipad


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Free! iMean

Large, simplifiedkeyboard Word prediction Speaks text Save to library 4.99

Type-n-Talk iBaldi Dragon Dictate

Dragon Go Works much like Siri Searches Google Maps

Voice-controlled

Internet search Open apps/play music

Sort of Aug Comm. Conversation Builder Talking Tom Soundnote &Notability


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Explore Aug Comm Apps Age Appropriate?

Type of Access?

Picture or Words orboth?

Library of phrases? Ease of use? Choice of voices? Can you hear it?

Using the Apps Practice with each Prioritize your top 3 for a

communication-impairedadult

Be able to explain yourchoices

Hearing ImpairedPower of texting

Instant messaging

In Accessibility panel,assign differentvibration patterns tofrequent callers(iPhone)

Hearing ImpairedPower of texting

Instant messaging

Tap Tap App

soundAmp

Visually Impaired http://appadvice.com/applists/show/apps-for-the-visually-impaired Uses Voice Over Accessibility feature

AriadneGPS

Money Reader Reads U.S. paper

money using your ipod/ipad 2 camera

See other Looktelproducts


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Assessment, Training &Follow-AlongTony Gentry, PhD OTR/LDepartment of Occupational Therapy


The Evidence for Cognitive Rehabilitation

Tabletop process-specific training works sometimes (especially

with attention) with some people (especially mildly impaired)

Computer-based remedial programs (and most other direct-

training efforts) do not transfer to real world settings

Compensatory approaches work, and work best when

individualized and offered within a supportive context (caregiver

training, community follow-along)

The strongest evidence for real world effectiveness of a

rehabilitation intervention is the use of cognitive prosthetics

Is what we do cognitive rehabilitation?

In clinical practice, there is general consensus that cognitive rehabilitation(regardless of the approach taken) should be directed at improving patientseveryday functioning and quality of life. (Cicerone, 2007)

for decades the field seemed trapped in an internal struggle over whether itis better to focus on training processes, skills, or functional abilities....

Though the struggle is not entirely over, it is increasingly acknowledged that

functional changes must be the goal of treatment, and that there are manyways to go about facilitating those functional changes. (Sohlberg & Mateer,2001)

As far as cognitive rehabilitation is concerned, we should be attempting to

remediate disabilityrather than impairment, or, at least, demonstrate thattreatment of impairment results in reduction of disability. (Wilson, 1997).

Interventions Are Best When:

They are person-focused, not discipline-focused

Clinicians work without boundary issues

Team is able to collaborate and see clients holistically

Ultimate goal is self-efficacy and self-regulation within

each clients chosen life experience

Holistic Perspective Strategies for thinking,

memory Environmental

adaptations Task simplification,

supports

Person Place

Task

Service Providers Role Assess client needs, tasks and

environment

Learn the devices

Determine best device forclient

Individualized suite of apps &strategies

Train client and caregiver

Include in daily organizationroutine

Follow-up consults

Gradually diminish supports


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Assessment FATCAT Tools/Features usednow Task requirements Goals/obstacles Familiarity/interest in

using AT Human supports

Like any other A.T., consider Does client have potential to use a device?

Functional vision

Hearing

Dexterity

Ability to respond to a prompt and performprompted task

Frustration tolerance

Awareness of need/Interest in using device

Which tool? Apple vs. Android vs. Microsoft vs. RIM? Will your clients plain vanilla cell phone do the trick? Pocket-size or tablet-size? Wi-fi only or cell phone access plan? School, work or all around use? Who will program the thing?

Interface issues Getting lost in so many

onscreen options The device itself as a

distractor Where do you put the thing? How do I protect the thing? Saving battery life Tinny, tiny speakers Inputting data

Pimp your ScreenSteve Jobs' Folder DemonstrationRecommend:Create a Work folderPlace work-related apps in this folderDrag Work folder to tray on bottom so

its always visibleMove non-work folders to secondscreen, not in tray

Another option: If only a few work-related apps, place them all in trayand not in a folder (easier to seethem that way).

Carrying PDA atwork

Pocket Belt clip Armband Desktop Lanyard


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Cases for ipod touch

Colortunes Walmart$9.95

Otterbox.comDefender$29.95

Turn off battery draining features

Turn off battery draining features More battery savers

Other battery savers

Set alarm tocharge me! at

night.

WhyBluetooth?


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Speaker solutions

iMainGo $15 (Walmart)Jabra $30(Amazon)

Keyboards*&*Styli*

Bluetooth keyboard Think about ergonomics Think about portability Thumbs or ten fingers?

Logitech di

novo

Apple full-size

Training Method Theory

Diffusion of Innovations

Instructional Design

Cognitive Rehabilitation

Build on Prior Familiarity

Repetition and Reinforcement

Multi-modal training tools

Focus on Real World Needs

Formative and Summative Assessment

Collaboration and Facilitation

Set-up & Training

Introduce a good basic device

Download software to persons pc

Introduce reminder alarm function for dailyschedule

Train family caregiver to trouble-shoot

Help person record 4-5 reminders each day for firstweek

Training

Contacts, Note Pad,Tasks, Memos

Pre-Test, Provide PDA, loadDesktop software, Intro to Data

Entry and Calendar

Trouble-shootingAdd appropriate apps

Trouble-shootingPost-test

Week1

Weeks 2and 3


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Support/Follow-Along

On subsequent visits, reinforce reminder alarmfunction

Work through problems

Introduce other features, as appropriate

Notes and To do lists

Video-based task cueing

Wayfinding tools

Accessibility features

Dont forget fun

Also consider: Workplace stimuli Protection of device How will it be carried? Home needs/uses

Post-Assessment How has A.T. reduced need for

supervision?

What new goals might be pursued?

What other technology may help?

If it didnt work, why didnt it?

Fading Supports Is this the right device for this person?

Gradually hand-off trouble-shooting to person andcaregiver

Consider disability-specific software

How can the device be leveraged for increasedindependence at school or on the job?

Be aware that new abilities lead to new opportunities

Collaborate on new ideas

Personalized Suite Reminders Task-Sequencing Cue Way-Finding Video Behavioral Management tool Communication or Device

Access Adaptations

Protective Case or Belt Clip Simplify Screen for Easy

Access Speakers? Keyboard? Behavioral Contract?

ATC Issues

Portability

Durability

Fit to Person, fit to tasks

Complexity vs. Functionality

Abandonment vs. Adaptation

Think of your car or tv.


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Functional Change

COPM Mean Scores n = 46

2.81

6.64

0

1

2

3

4

5

6

7

8

9

10

1 2

Pre-Test andPost-Test

MeanScores(10-pointscale)

Autism GroupN = 22!

2.54

7.83

0

1

2

3

4

5

6

7

8

9

1 2

Pre-Test andPost-Test

MeanScores(10-pointscale)

TBI GroupN = 24!

Comments

I am absolutely amazed at how that device is working. It is incredible!

The second it goes off, D___ jumps up and completes his task. I amso excited about the possibilities for his independence andresponsibility level.

(mother of 14 year old boy with autism)

Before I got this PDA, I wouldnt even remember to eat half the t ime.Now Ive got alarms for my medicines and appointments, mypasswords, my homework, even directions to places in town. It makesme feel like maybe I can do things on my own at last.

(16 year old with Aspergers Syndrome)

FATCAT Themes Gratitude:At last something helped me!

Medication Management: I feel better!

Organization: I can keep track of my day,gaining control over my life.

Self-efficacy: Being able to do more makes mewant to do more.

Implications - Clinical

A brief training intervention with PDAs works

Affordable, readily available device

No social stigma for user

Improves functional performance and self-efficacy

Not a one-size-fits all therapy

The potential for computers as cognitive-behavioral aids is enormous

Initial Lessons I Learned

You cant throw these things at people and run

You have to provide long-term follow-along

Expect needs and goals to change

Expect new technologies to offer additional

opportunities

Collaborate learn from your clients

Funding AT for CognitionDoes not consider consumer

products as assistive technologyTypically, yes, if

vocationally relevantVeterans Affairs, pilot school-work

transition programsACT not particularly expensive


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Billing and Codes: CPT ADL/Home Management #97535

activities of daily living (ADL) and compensatory training, mealpreparation, safety procedures, and instructions in use of assistivetechnology devices/adaptive equipment (inc home environment/modif analysis)

Community/work reintegration training #97537 Community/work reintegration training (eg, shopping, transportation,

money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technologydevice/adaptive equipment

Billing and codes continued Cognition skill Development (3421351)# 97532

Development of cognitive skills to improve attention,memory, problem solving, (includes compensatory training)

Assistive Technology Assessment #97755

To restore, augment or compensate for existing function,optimize functional tasks and/or environmental accessibility(for assessment and reassessment only)

Gentry, T. (2010). Wallace, J, Kvarfordt, C., &

Lynch, K.B. (2010). PDAs as cognitive aids foradolescents with autism: Results of a community-

based trial. Journal of Vocational Rehabilitation. 32:101-108.

(2008). PDAs as cognitive aids for individualswith multiple sclerosis. American Journal of

Occupational Therapy. 52: 444-452.Wallace, J. (2008). A community-based trial

of pdas as cognitive aids for individuals with acquiredbrain injury: Outcome findings. Brain Injury. 33:

21-27.

Joey Joey is a 20-year gentleman with autism and OCD, who received a high school certificate one year ago. He is non-verbal,

but reads well and understands spoken language. In school he had used a Dynavox for communication, but no longer hasthe device and has begun to make fewer and fewer efforts at communication in the past year. He has one of the newNintendo DS-3D portable game devices, and seems to spend most of his time lost in play on complex puzzle games.

You have been called in to help him find, and succeed at, work, and are beginning a job trial with Joey at a local pet store that

has several employees with disabilities. Joey is being asked to do several complex tasks at the pet shop. In the morning, heremoves mice and gerbils from their cages, puts them in boxes, and cleans their cages, replacing old bedding with new, andthen putting the animals back. He then feeds and waters them. There are ten cages in all. If he moves through the tasksteadily, it should take most of the morning to get this done. If a customer asks for help, he is expected to respond kindly andoffer them help or direct them to someone who can help. In the afternoon, he helps the shop owner manage reptiles.Though he doesn't have to touch the animals, he is expected to wash down their glass tanks (there are 12 tanks in all). In hisfirst week on the job, Joey does well when working directly with the owner, but cannot seem to stay on task during hismorning routine. He wanders off to look at the fish, or compulsively cleans one cage until it is spotless (then starts all overagain on it), and he has never cleaned more than three cages in a morning yet. If he cannot learn to work independently atthis task, he cannot graduate to more varied tasks and may lose his job. He seems to be aware of this, and it is making himincreasingly anxious. There is another problem. Joey's parents both work, and he needs to be able to take care of hismorning routine and walk to the pet shop on time for work. You have had to meet him at home every day this week, and walkwith him to the shop, but he has been late every day.



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Putting it all together

Tony Gentry, PhD OTR/LDepartment of Occupational Therapy


Johnathan 28-year old retired OIF

officer Multiple concussion

blast TBI PTSD Pre-Med student at

VCU

Situation Ambitious and over-scheduled Must get excellent grades for med school Missing assignments/appointments Difficulty following lectures in busy classroom Hyper-vigilant and high anxiety Forgets meds so sleeps poorly; fear of over-

medicating

iPad 2 iCal forAppointments iStudiezPro for

Homework Notability for Note-

taking and lecturerecording (withstylus)

Sometimesphotographsassignments fromchalkboard

Health apps Pillboxie for pills PTSD Coach for

tracking symptoms Breathe-2-Relax

Peripherals

Griffin Survivor ExtremeCase - $58

Olympus m-2 noise-cancelling microphone- $25

Walmart stylus - $12


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All As winter semester

Khan Academy QuickOffice Pro Dropbox

Case Study Stephanie Lau, VCU RRTC and her client Beth

57-year oldVirginia

EmploymentCommission file

clerk

Situation Environmental Adaptations Organized work flow with written instructions But still required close supervision for:

Switching tasks, way-finding in building, anxiety-management, changes in routine, transportationsafety

Contacts

Task Notes Reminders


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Videos Anxiety Management Simply Being Guide meditation app

with music and voice Timer .99 on iTunes Store

Entertainment Result Manages bus difficulties with reminders, phone, and

music Moves from task to task on time (alerts) Knows what to do (notes) Finds her way, observes appropriate, safe behaviors

(videos) Relaxation and anxiety-management (apps and

music)

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Alissa&Molinelli&

Job Coach

Project Search St. MarysHospital

Richmond


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Annie 20 year old with Downs Syndrome and ASD dx High school certificate Does not read, tell time, or understand calendar Can follow a visual schedule, but needs direct

supervision with task transitions, changes in routineand distractions

Generally sociable, but can tantrum

Annies job trial

Custodial work in hospital lactation room

Cleans computers, COWs, refrigerator, folds towelsand gowns, etc.

5 days/week, 5 hour days, $8.00 hour Participated in Project SEARCH training On job one month

Issues to addressClock in/out, lunch and work breaksDifferent tasks on alternating daysTransition between tasks independentlyDeal with disruption of routineFrustration when she doesnt know what to doManaging bus ride to/from work

iPod Touch?

Reminders Spoken reminders so

no need to read screen Reminders spoken by

Annie herself forownership of task

Disneytune at daysend!

Pink & Purple Days Created purple and pink calendars on iCal Created an all-day event for each day She opens iCal with one tap and sees the day high-

lighted in pink or purple She goes to Storykitand opens either the pink or the

purple story to cue her task sequences


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5

Storykit Task-Sequencing i-Reward

Reward Games FaceTime Ask questions of job

coach Job coach can check

in virtually

Simplify & Personalize Screen Summary iCalto find out which alternating work day Storykitto choose appropriate task-

sequencing book i-Reward to get a star for good behavior Game play can be used as a reward Reminder alarms using VoCalapp for cues

during the day Reminder at home to charge me! Communicate at work via Facetime Customize interface for ease of use


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Outcome Initial iTouch setup and training required about 4

hours Annie can self-manage device Job coach immediately recorded reduction of

direct supervision hours But then, she lost the device!

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5

10

15

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25

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Lanyard case Discussion?

Your turn Groups of 4 Read case study Consider your options Choose a device

What strategies/apps

will help?

Create a work folder Put folder in tray Add the apps you will

use How will you protect

device? Other peripherals? Plan to discuss your

solution.


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