Cognitive Support Technology Research Articles

Cognitive Support Technology for People with Intellectual Disabilities: Factors for Successful Implementation

In Europe, large numbers of people with disabilities are willing to work but have problems finding a job. One of the barriers to this is job complexity, particularly for those with low education, low IQ, or cognitive impairments. Digital technologies might help. Specifically, cognitive support technology (CST) has the potential to make jobs less complex and thus more accessible. CST may concern step-by-step digital instructions presented with monitors, tablets, smart phones, beamer projections, or near-eye displays. Based on cross-case evaluations, we aimed to define the success factors in the process of technology selection, development, and implementation. Four cases, situated at public social firms which offer jobs to people with disabilities, were selected. In each case, the optimal form of CST was selected. A qualitative analysis of subjective experiences of work accessibility, performance, usability, and acceptance was applied. The results were positive for most participants in most cases. Once installed, the CST was successful in simplifying jobs. A proportion of the workforce for which a specific job had been considered too complex was able to perform that job when supported by CST. Moreover, a majority of people judged the usability of the technology positively. For the consecutive steps of selection, development, and implementation, we ended up with eleven factors of success; these included, among others, shared and transparent decision making (in technology selection), the iterative and active involvement of workers to optimally adjust work instructions (in technology development), and explicit attention for psychosocial barriers (in technology implementation).

Cognitive Support Technologies for Adolescents with Disabilities: Impact on Educator Perceptions of Capacity and Opportunity for Self-Determination

Research has suggested that adding cognitive support technologies to the transition planning process enhances student self-determination above and beyond traditional, book or paper-based self-determination curricular materials. However, limited research has examined how teachers perceive the impact of cognitive support technologies on student capacity and opportunity for self-determination. The present study used multivariate analysis of covariance to examine teacher perceptions of student capacity and opportunity for self-determination over time based on group random assignment to a self-determination curricula alone group or a self-determination curricula plus cognitive support technology group. The impact of disability label (learning disability vs. intellectual disability) on educator perceptions was also examined. Findings suggest a complex pattern of differences over time; there was a multivariate effect for the interaction of time, disability, and technology access, but when decomposing these differences at the univariate level, the primary differences were in educator ratings of capacity, not opportunity. Differences based on disability label were also found, with educators rating students with intellectual disability significantly lower in their capacity for self-determination, but not opportunity. Implications for future research and practice are discussed.

НОВЫЕ ЗАДАЧИ КОГНИТИВНОГО СОПРОВОЖДЕНИЯ РАННЕЙ ПРОФОРИЕНТАЦИИ ШКОЛЬНИКОВ НА ЦИФРОВОЙ ОБРАЗОВАТЕЛЬНОЙ ПЛАТФОРМЕ (НА ПРИМЕРЕ ДЕЯТЕЛЬНОСТИ АНО ДПО «ОТКРЫТЫЙ МОЛОДЁЖНЫЙ УНИВЕРСИТЕТ»)

Introduction. The focus of modern society on building functional literacy skills in specialists, the development of cognitive abilities based on fundamental education, and others determined the objective of developing scientific knowledge about early career guidance for schoolchildren, including the cognitive support of this process on a digital educational platform. The study aims to justify the cognitive support technology for early career guidance for schoolchildren on a digital educational platform (on the example of the activities of ANO CPE “Open Youth University”) and formulate new objectives for the development of this technology in the present stage of education development. Materials and Methods. The methodological framework of the study employs a network approach in education, which contributed to the justification of the educational ecosystem “Non-profit organization – digital educational platform – school;” the leading principles of the system activity approach, which ensure the development and testing of the content of the technology for cognitive support of early career guidance of schoolchildren in the context of this ecosystem; personality-oriented approach, which allows personalizing the process of career guidance work; cognitive approach, which contributes to the substantiation of the content of the technology at issue and is aimed at orientating schoolchildren’s career guidance towards the generation of scientific ideas and the development of the cognitive sphere of adolescent personality. The study was carried out within the framework of the regional project “Territory of Intelligence” implemented in the Tomsk region. Results. The paper has systematized scientific ideas about the system of career guidance; justifies the technology for cognitive support of early career guidance for schoolchildren on a digital educational platform and identifies the objectives for the development of this technology. The scientific novelty of the study is related to the fact that this is the first time the technology of cognitive support for early career guidance of schoolchildren on a digital educational platform has been substantiated. The theoretical significance of this work is due to the systematization of scientific ideas about the process of early career guidance of schoolchildren by means of educational platforms. Conclusion. The content of the digital educational platform developed in the study, cognitive technology for supporting the process of career guidance for schoolchildren, and the method of building the ecosystem “non-profit organization-digital educational platform-school” are of practical value for school principals and teachers.

A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns.

BackgroundAssistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption.ObjectiveThis study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention.MethodsThe ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days.ResultsData from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters.ConclusionsFor participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.

An Organizational Case Study of a 5-Year Development Project to Promote Cognitive Support Technology Use, Academic Success, and Competitive Employment Among Civilian and Veteran College Students With Traumatic Brain Injuries

Project Career was a 5-year interdisciplinary development initiative funded by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). The project merged cognitive support technology (CST) with best practices in vocational rehabilitation to improve postsecondary and employment outcomes for veteran and civilian undergraduate students with traumatic brain injuries (TBIs). Project staff conducted assessments of students' needs relative to assistive technology, academic achievement, and career preparation; provided CST training to 146 students; matched students with mentors; provided vocational case management; delivered job development and placement assistance; and maintained an electronic portal regarding academic accommodations and career resources. A single-group, quasi-experimental analysis revealed that Project Career students significantly improved their psychological outlook on their education and their careers, academic performance, persistence toward degree completion, and prospects for competitive careers after graduation. Project Career provides a national model based on best practices for helping postsecondary students with TBI to attain their academic and career goals.

Point-of-care Cognitive Support Technology in Emergency Departments: A Scoping Review of Technology Acceptance by Clinicians.

Cognitive support technologies that support clinical decisions and practices in the emergency department (ED) have the potential to optimize patient care. However, limited uptake by clinicians can prevent successful implementation. A better understanding of acceptance of these technologies from the clinician perspective is needed. We conducted a scoping review to synthesize diverse, emerging evidence on clinicians' acceptance of point-of-care (POC) cognitive support technology in the ED. We systematically searched 10 electronic databases and gray literature published from January 2006 to December 2016. Studies of any design assessing an ED-based POC cognitive support technology were considered eligible for inclusion. Studies were required to report outcome data for technology acceptance. Two reviewers independently screened studies for relevance and quality. Study quality was assessed using the Mixed-Methods Appraisal Tool. A descriptive analysis of the features of POC cognitive support technology for each study is presented, illustrating trends in technology development and evaluation. A thematic analysis of clinician, technical, patient, and organizational factors associated with technology acceptance is also presented. Of the 1,563 references screened for eligibility, 24 met the inclusion criteria and were included in the review. Most studies were published from 2011 onward (88%), scored high for methodologic quality (79%), and examined POC technologies that were novel and newly introduced into the study setting (63%). Physician use of POC technology was the most commonly studied (67%). Technology acceptance was frequently conceptualized and measured by factors related to clinician attitudes and beliefs. Experience with the technology, intention to use, and actual use were also more common outcome measures of technology acceptance. Across studies, perceived usefulness was the most noteworthy factor impacting technology acceptance, and clinicians generally had positive perceptions of the use of POC cognitive support technology in the ED. However, the actual use of POC cognitive support technology reported by clinicians was low-use, by proportion of patient cases, ranged from 30% to 59%. Of the 24 studies, only two studies investigated acceptance of POC cognitive support technology currently implemented in the ED, offering "real-world" clinical practice data. All other studies focused on acceptance of novel technologies. Technical aspects such as an unfriendly user interface, presentation of redundant or ambiguous information, and required user effort had a negative impact on acceptance. Patient expectations were also found to have a negative impact, while patient safety implications had a positive impact. Institutional support was also reported to impact technology acceptance. Findings from this scoping review suggest that while ED clinicians acknowledge the utility and value of using POC cognitive support technology, actual use of such technology can be low. Further, few studies have evaluated the acceptance and use of POC technologies in routine care. Prospective studies that evaluate how ED clinicians appraise and consider POC technology use in clinical practice are now needed with diverse clinician samples. While this review identified multiple factors contributing to technology acceptance, determining how clinician, technical, patient, and organizational factors mediate or moderate acceptance should also be a priority.

Project Career: An individualized postsecondary approach to promoting independence, functioning, and employment success among students with traumatic brain injuries.

Project Career is a five-year interdisciplinary demonstration project funded by NIDILRR. It provides technology-driven supports, merging Cognitive Support Technology (CST) evidence-based practices and rehabilitation counseling, to improve postsecondary and employment outcomes for veteran and civilian undergraduate students with traumatic brain injury (TBI). Provide a technology-driven individualized support program to improve career and employment outcomes for students with TBI. Project staff provide assessments of students' needs relative to assistive technology, academic achievement, and career preparation; provide CST training to 150 students; match students with mentors; provide vocational case management; deliver job development and placement assistance; and maintain an electronic portal regarding accommodation and career resources. Participating students receive cognitive support technology training, academic enrichment, and career preparatory assistance from trained professionals at three implementation sites. Staff address cognitive challenges using the 'Matching Person with Technology' assessment to accommodate CST use (iPad and selected applications (apps)). JBS International (JBS) provides the project's evaluation. To date, 117 students participate with 63% report improved life quality and 75% report improved academic performance. Project Career provides a national model based on best practices for enabling postsecondary students with TBI to attain academic, employment, and career goals.

Cognitive Support Technology

Increasingly, traumatic brain injury (TBI) is a serious public health problem affecting ~1.7 million Americans each year. Over 75% of TBIs are classified as mild and these rates are most likely underestimated. Despite the low severity rating, 5-15% of individuals go on to develop chronic, persistent TBI-related symptoms causing functional limitations. Project Career is an interprofessional demonstration providing continued support and services to 2-year and 4-year college students with a history of TBI. This program is designed to improve the employment success through a combination of assistive technology on iPads and individualized career counseling services as undergraduate students transition from university settings to the workplace. This demonstration presentation will engage participants in understanding the Project Career assessments and iPad Apps. Using a case study approach, participants will appraise appropriate Apps and advance their understanding of how the iPad can be used an an educational tool and cognitive support technology (CST).

Promoting cognitive support technology use and employment success among postsecondary students with traumatic brain injuries

OBJECTIVE: This article applies positive psychology principles to the purpose and objectives of a five-year, federallyfunded initiative to provide cognitive support technology (CST) training and career preparatory services for undergraduate college students with mild and moderate traumatic brain injuries (TBI). METHODS: A total of 48 students with TBI have participated in the project during its first 18 months of operation – 14 of whom are military veterans with disabilities who were in the Iraq and/or Afghanistan theaters. CONCLUSION: Positive psychology interventions such as Best Possible Self, Intensely Positive Experiences, and Assetbased Assessments provide a framework for examining the activities of this multi-site development project.

Activities and interim outcomes of a multi-site development project to promote cognitive support technology use and employment success among postsecondary students with traumatic brain injuries

This article describes the activities and interim outcomes of a multi-site development project called Project Career, designed to promote cognitive support technology (CST) use and employment success for college and university students with traumatic brain injuries (TBIs). To obtain early intervention results from participants in Project Career's first 18 months of operation. Fifty-six students with TBI have participated to date across three implementation sites in Massachusetts, Ohio, and West Virginia, with 25 of these participants being military veterans. Descriptive analyses provide information regarding the participants, the barriers they face due to their TBI in obtaining a post-secondary education, and the impact services provided by Project Career have had to date in ameliorating those difficulties. Inferential statistical analyses provide preliminary results regarding program effectiveness. Preliminary results indicate the program is encouraging students to use CST strategies in the form of iPads and cognitive enhancement applications (also known as 'apps'). Significant results indicate participants are more positive, independent, and social; participants have a more positive attitude toward technology after six months in the program; and participants reported significantly improved experiences with technology during their first six months in the program. Participating students are actively preparing for their careers after graduation through a wide range of intensive vocational supports provided by project staff members.

Cognitive support technology for transitions age service users

Background: Identified small cohort of 5 users who did not meet the Fair Access to Care Services eligibility thresholds but could do in the future without some form of intervention Most young people identified for the project had needs regarding Autism and behavioural problems Young people identified were not accessing Education/ Training or Employment Needed support regarding independent living skills which is a key government outcome Small project was established Spring 2013 to determine if a cognitive support technology intervention could lead to increased independent living skills and to reduce the likelihood of requiring future services Service Delivery: Joint Project Steering Group established between Children and Adult Services, Connexions, Occupational Therapy, Bucks New University and private sector technology provider Connexions identify potential users requiring lifestyle management such as travel traning, task scheduling, access to employment, etc. Cases discussed at Project Steering Group and then discussed between OT and family If all parties in agreement, OT conducts joint assessment with technology provider Occupational Therapy provides up to six follow up sessions and Connexions deliver on-going support OT re-assesses at end to see what progress has been made regarding increased independence Initial Findings: 11 users identified to date, with target of 15 by year end 6 young people are now receiving this intervention and have relevant equipment 3 have been referred onto occupational therapy for further support and then will receive the technology appropriate to their need e.g. smart phone for user to use supporting route planner to access bus to work, or smart tablet to help user schedule ingredients required to prepare healthy meal independently International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116448– http://www.ijic.org/ 2 families have already identified a significant reduction in stress at home and improvement in family relationships Increased independence for user Potential cost avoidance savings in the future for one of the users identified to be in the region of £40k (supported living) Positive reception on project findings from Children’s Joint Executive Team last November Outcomes: Short term Occupational Therapy support has proven to be very effective for families Use of the technology is beginning to up skill the cohort and 1 user now can cook independently of the technology Without this intervention, 1 user would have likely ended up in supported living which would have ultimately been more costly Overall health for 1 user would have significantly deteriorated in the next few years due to lack of knowledge about nutrition and how to prepare healthy meals All have improved independent living skills especially regarding travelling along and cooking . Evaluation of project in partnership with Bucks New University Positive media coverage via local papers and TV Future: Project group are looking into other potential groups that are currently in college or sixth form Investigating potential transferability of cognitive support technology to other groups e.g. users with a Dementia, Neuro-Rehab, CAMHS, Children’s OT. Recognised that the earlier the intervention, the more likely users will be prepared for move in adulthood and less likely need for traditional, higher cost provision Extension of project into 14/15 Part of wider discussion in relation to Adult, Children and NHS Services approach to future joint commissioning of AT

Poster 1: Assessing the Match of Person and Cognitive Support Technology

Objectives: To evaluate the Cognitive Support Technology Predisposition Assessment (CST PA), and to develop content for CST PA computerized scoring and interpretations and a CD training program for rehabilitation professionals. Design: National experts assisted in the development of the content of the materials. Professional, consumer, and caregiver feedback was obtained on the prototype CST PA. Setting: Professional experts represent various cognitive rehabilitation programs throughout the United States.