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30 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

outcome, such as whether or not a person will initiate the seeking of technology, the
length of time the technology is used and whether or when changes to existing needs are
likely to occur. Thus, depending on the level of residual capacity (Robertson and Murre,
1999), those with an acquired neurocognitive disorder may need a high degree of support
and instruction in the initial stages, but once the use of a device has been learned and
accepted, few adjustments may be required (Rispoli et al., 2014; Wong et al., 2016). In this
case, discontinuation of a device may indicate a good outcome – where the person has
regained a lost function and the support from technology is no longer needed (Bergman,
2002; Brown et al., 2012; Oddy et al., 2013). The prognosis for progressive disorders tends
to be a less positive one. When the process of assistive technology delivery is initiated,
prescribers, end-users and their support network need to gain an understanding of the
changing needs associated with the condition, manage expectations and schedule regu-
lar follow-ups, which will enable early identification of the need for adjustments. In the
case of neurodevelopmental disorders, specific cognitive developmental milestones may
need to be achieved as a prerequisite to introducing and benefiting from some technol-
ogies. For example, Light and Drager (2007) highlight the importance of being able to
understand true relationships between cause and effect, as the individual will rely on this
complex cognitive ability to master the control of their actions on objects that are physi-
cally displaced from each other, a skill that is constantly required when using EATs (e.g.,
actions on keyboard and mouse have effects on screen). On the other hand, as the symp-
toms and their effect on functional ability change over the course of development, so will
the individual’s support needs, but the response to these will need to take into account
the demands posed by the context at different stages of the individual’s lifespan (e.g.,
school vs. employment). What is seen as acceptable in school may no longer be so in col-
lege or at work. The degree of support available to use technology may also vary across
different environments.

Specific Versus Generalised Cognitive Impairment

Whether impairment is specific to a particular area (e.g., memory) or generalised to more
areas is another distinction present in most diagnostic categorisation systems such as the
DSM and the ICD. Such distinctions function as criteria for differential diagnosis between
specific cognitive syndromes or learning difficulties, such as dyslexia (specific reading
disorder), and generalised ones, such as learning disability, or amnesia versus dementia.
However, and perhaps more importantly from an intervention and technology assess-
ment perspective, these differences also delineate what intervention strategy is likely to be
effective. Those with specific cognitive impairment, whether developmental or acquired,
are likely to present with limited cognitive deficits and most other skills intact (Harvey,
2012). This will have implications to the individual’s ability to acquire new knowledge
or strategies. As Sayko and Tremoulet (2015) point out, often the very cognitive disabil-
ity that technologies are designed to support may make adoption more challenging. This
would be especially the case in individuals with generalised cognitive impairment whose