Page 48 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 35

through their morning routine (O’Neill & Gillespie, 2008; O’Neill et al., 2013). Another
example is COACH, an auditory and visual system designed to help guide people with
dementia through hand washing (Mihailidis et al., 2000). A systematic review highlighted
the single case experimental design research that has demonstrated the efficacy of micro-
prompting devices (Jamieson et al., 2014) and, in a randomised control trial, GUIDE was
shown to be as effective as clinical rehabilitation from human caregivers at supporting
morning routines (O’Neill et al., 2017). The literature also highlights the dual utility of
guidance technologies depending on the patient’s ability to learn new skills; for some par-
ticipants, use of the guiding technology over a lengthy period led to habit formation that
allowed them to stop using the technology. For others, with more severe memory impair-
ment, the compensatory technology would always be required.
Successful use of assistive technologies is rarely effort free and often involves a series of
substeps to achieve a goal. This can make it difficult for people with executive difficulties
to use EAT successfully without guidance. This is especially true when technology use is
novel, where somebody has cognitive difficulties that mean they find it difficult to form
a habit or when individuals become distracted during the performance of an activity. In
these situations, microprompting technology could be a useful solution. The prosthetic
limb donning in the GUIDE study (O’Neill et al., 2008) is an example of cognitive impair-
ments precluding the use of a health technology. Even in cases where somebody does have
the capacity to learn the new skill, it can be difficult to provide human support at the right
moments for long enough and consistently enough. Technology has the ability to supple-
ment this kind of support in a cost-efficient and effective way.

Memory

Memory difficulties can affect technology use in a number of ways. As discussed previ-
ously, difficulties with forming new memories can prevent learning from mistakes, which
means that unfamiliar technology can only be successfully introduced using errorless
learning techniques. Short-term or working memory difficulties can also lead to difficul-
ties with keeping track of a task with several substeps. Prospective memory (PM), the pro-
cess of creating and acting upon a future intention, can also affect the use of EAT.
PM tasks can be categorised in terms of their antecedent. Time-based PM tasks should
be completed at a preset time (e.g., take medication at 12 p.m.) and event-based PM tasks
should be completed after a certain event, e.g., take medication after lunch (Ellis, 1996).
Furthermore, PM tasks can be categorised as pulse or step tasks. A pulse task has to be
completed at an ideal moment – either time based (e.g., get to the GP’s office at 2 p.m.
for appointment) or event based (e.g., buy milk when passing the shops on the way home
from work). Step tasks do not have a specific moment when the task should be completed
but usually have a window of opportunity either based on time (e.g., email your colleague
between 9 a.m. and 2 p.m.) or an event (e.g., email your colleague while you have internet
access on the train at some point during the journey). PM failure is common in people
with neurological impairment and is usually conceptualised as the failure to remember a