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28 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

including electronic assistive technology (EAT). Failure to account for these important fac-
tors results in increased risk of nonuse, discontinuance (Phillips and Zhao, 1993) and poor
user satisfaction.
In their seminal book Neuropsychological Assessment, Lezak et al. (2004) argued that
cognitive functions (i.e., those concerned with information processing) have been the
main focus of attention when assessing behaviour in patients with brain pathology,
because impairments in this area are very prominent, and because they are more ame-
nable to being operationalised, measured and correlated with the underlying neural sys-
tems. However, the authors also note that brain damage rarely affects only cognition, and
that emotionality (i.e., concerning feelings and motivation) and executive functions (i.e.,
comprising control on how behaviour is expressed) are likely to be involved, regardless of
the size and location of the pathology.
Cognitive impairment is common to most brain pathologies (Sachdev et al., 2009;
Skaper et al., 2014). However, there is significant variation in terms of severity, presen-
tation and course (Libon et al., 2007; Lillo and Hodges, 2010; Sachdev et al., 2004). An
understanding of a person’s neuropsychological profile will inform technology prescrib-
ers on the factors that influence each individual’s behaviour and their ability to engage
and be supported by technology. The need for knowledge of the subjective dimensions
of behaviour and individual functioning in the context of the surrounding environment
has been acknowledged in the relevance afforded to the role of the psychologist within
the assistive technology assessment process (Federici et al., 2014a,b). Further under-
standing of these factors from a technological perspective will, in turn, enable technology
designers, or psychotechnologists (Federici et al., 2014a,b) to find the best match for each
individual, and address the through tailored design. This chapter will consider the three
key areas of cognition, emotionality and executive function. It will examine how these
might affect a person’s ability to use and benefit from technology, and the strategies and
techniques available to technology prescribers and designers to address some of the chal-
lenges they pose.
At an individual level, cognitive, emotional and executive impairments present in many
forms, however, it is possible to delineate general characteristics, which can guide and
inform the assessment process and afford some degree of ability to predict user agreement
and service efficiency, effectiveness and satisfaction.
There is no single or widely accepted method to assess cognitive functioning, and the
use of any tool must be accompanied by an understanding of the individual’s charac-
teristics and aetiology of the illness or injury that led to cognitive impairment. Typically,
the tools available have been designed and validated for use with specific age or clini-
cal groups, or developed to assess different aspects within a particular cognitive domain
(e.g., executive function). In many cases, only a full assessment by a neuropsychologist
will enable technology prescribers to gain an understanding of the range and interac-
tion between different aspects of function. However, screening tools are available, which
help determine whether and to what extent, cognitive impairment is likely to be present.
Cullen et al. (2007) provide a review of different screening tools for different purposes.