Page 44 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 31

difficulties, which go beyond the specific ability or function a device is designed to address,
may impair their capability to accept, learn and adjust to a device. Few studies have inves-
tigated the impact of cognitive impairment on people’s ability to use and benefit from
technology (Cullen et al., 2008; Kaye et al., 2008), but initial evidence suggests that it may
play an important role. For example, van Walsem et al. (2016) found that technology was
more likely to be used by patients in the earlier stages of Huntington’s disease, suggesting
that severity of cognitive impairment may be a predictive factor. In contrast, Hughes et al.
(2014) found that in the patients’ and carers’ perspectives, ease of set-up and comfort were
key factors of an ideal technology. Thus easiness and comfort may pose more of a chal-
lenge precisely to those who would in principle benefit the most from technology.
Specific deficits can be very severe; however, preserved cognitive ability in other areas
is likely to increase the potential to and enable learning (Robertson and Murre, 1999),
including the development of strategies that make technology use more likely and effec-
tive. It is possible that some of these problems can be addressed through intelligent design
and the development of zero-effort technologies (Mihailidis and Boger, 2011); however,
features like these may influence acceptability among more able end-users if they are per-
ceived to be specific to assistive technologies (Parette and Scherer, 2004).

Other Neuropsychological Factors

The distinction between developmental and acquired, and between specific and gener-
alised cognitive impairments, can give some indication of an individual’s ability to learn
and effectively use technology. However, these distinctions cannot be interpreted in isola-
tion. A number of other factors will interact with the medical or psychological diagnosis a
person presents, and modulate the extent of its impact on function.

Impaired Self-Awareness

Many individuals with neurocognitive impairment are not able to accurately perceive dif-
ficulties or changes in their own level of functioning (Chiao et al., 2013; Shany-Ur et al.,
2014). These difficulties may arise as a direct result of neurological damage, or they may be
a psychological response to disability (Katz et al., 2002). Anticipatory awareness (Crosson
et al., 1989), which can be conceptualised as a milder form of lack of awareness, presents
as an inability to predict and compensate for one’s difficulties before situations where
the abilities required are called upon. In its most severe form, lack of intellectual aware-
ness (Crosson et al., 1989) presents an inability to recognise that a difficulty is even pres-
ent. Impairments of self-awareness are linked to poorer outcomes (Kelley et al., 2014).
If the person does not recognise they have a problem, they are less likely to accept and
engage in therapy, and less likely to use compensatory strategies, including EAT (Katz
et al., 2002; O’Neill and Gillespie, 2015). In such cases, an initial intervention to facilitate
engagement, the use of zero-effort technologies or more intensive support from carers
may be required.