PDAs and Cognitive-Communicative Disability ________________________________________________

1. PDAs and Cognitive-Communicative Disability ________________________________________________ The University of Akron School of Speech-Language Pathology and Audiology Yvonne Gillette, yg@uakron.edu Roberta DePompei, rdepom1@uakron.edu

2. 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

3. Research Phases: 1- Alarm Response Studies 2- Extended PDA Training Sessions 3- Smartphone Studies

4. Phase 1 Alarm Response Studies

5. 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?

6. 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.

7. Mean Rate of Responding Across Condition (Baseline, Planner, Dell, Palm) 100 90 80 70 60 Weeks 1-4 Mean Rate of Responding 50 Weeks 5-8 40 30 20 10 0 SA- A-TBI A-ID SA- A-TBI A-ID SA- A-TBI A-ID SA- A-TBI A-ID ID/TBI ID/TBI ID/TBI ID/TBI Baseline Planner Dell Palm Condition by Population Mean Rate of Responding Across Condition

8. 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

9. 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

10. 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

11. 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

12. School-Age Alarm Response Results

13. 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)

14. 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%

15. 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

16. 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) School-Age StudiesExit Survey, cont.

17. Case Studies: Phase 1

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

19. RW - Video

20. RW: Alarm Response Studies Results

21. Subject Description: MB • Male • Age 14 • Intellectual Disability • Special education classroom/middle school • Limited literacy skills; good verbal skills • Dell Pocket PC

22. MB: Alarm Response Studies Results

23. Summary of Significant Findings* *Refer to previous Alarm Response Studies tables.

24. Phase 2 Extended PDA Training Sessions

25. 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

26. 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. PrePost 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

27. Group Results:Extended PDA Training Sessions: Functions and Features (cont.) PrePost Calculator 4 6 Notes Text 1 4 Voice 2 6 Games Jawbreaker 1 2 Solitaire 1 1 Tetris 0 4 Beaming 0 4

28. Group Results:Extended PDA Training Sessions: Functions and Features (cont.) PrePost 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

29. Case Studies: Phase 2

30. 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 RW: Extended PDA Training Sessions – Palm Functions Used

31. RW – Task List Video

32. 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 MB: Extended PDA Training Sessions – Dell Functions Used Did not use pre or post:

33. MB- Dell Calendar Video

34. MB Teaches Another Student to Use the Dell Video

35. PDA to Smart Phones a Logical Next Step for Universal Access/Design Everybody's Gotta Have One!

36. Phase 3 Smartphone Studies

37. 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

38. Case Studies: Phase 3

39. 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

40. RW – CellContacts Video

41. 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

42. MB – Cell Contacts Video

43. MB – Cell Picture Video

44. MB – Cell Text Message Video

45. 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

46. “It’s changed my life…”

47. “What I Really Like…”

48. 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

49. 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?)

50. 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 good • Disseminate to clinicians/teachers/support people who can make a difference on a daily basis • Inform policy makers/third party payers