Page 52 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 39

getting caught up in a task I could complete anytime, when it would make me late for a
time-dependent appointment. The fact that this goal-dependent sustained or switching
of attention can be impaired should be taken into account when designing and providing
EAT for people with cognitive impairments. For example, it could be useful to prompt the
use of a communication or memory aid each time it is necessary. Additionally, if someone
has to learn to use technology over a long period, then it may be beneficial for some to
be supported to learn to use technology, and develop use into a habit, through a course
of intensive sessions, rather than simply providing the technology and expecting that the
person will learn to use it in their own time.
Manly et al. (2002) showed that, when performing a task during which the test taker
must switch attention between a number of other ongoing tasks, none of which can
be fully completed in the time given, sporadically presenting auditory beeps increased
the ability of participants with difficulties switching attention to complete more of the
set tasks (Manly et al., 2002). This ‘content-free’ cueing was investigated further by Fish
et al. (2007), who used a combination of goal management training and a text message
saying ‘STOP’ to increase people’s performance on a memory task (Fish et al., 2007). In
the goal management training sessions, participants were encouraged to stop and think
about what their tasks were during the day, encouraging the switching of attention from
current environmental stimuli and current tasks to goal-directed tasks. The ‘STOP’ mes-
sage was associated with thinking about goals and the eight text messages sent at random
times during the day acted as a trigger for this attentional switch. The text messages were
successful at improving performance on the memory task for 20 participants with brain
injury. These examples show the role that an assistive technology intervention can have on
the performance of everyday tasks, and these everyday tasks could include the use of EAT
or training with EAT.

Implications for Technology Use

We have outlined different cognitive difficulties that might impact the use of EAT.
However, when using EAT as a clinical tool the cognitive abilities of the user are just one
factor to consider. When discussing the use of assistive technology for cognitive impair-
ment, O’Neill and Gillespie (2014) refer to the neuro-socio-technical model that takes into
account the myriad influencers in the environment, the users themselves and the technol-
ogy. Importantly, these aspects cannot be fully understood individually (O’Neill & Findlay,
2014). With this in mind we will now look at some of the literature that has attempted to
investigate the use of EAT by people with cognitive impairments in context, and discuss
the issues that clinicians should bear in mind when working with clients who use EAT, and
when introducing technology as a clinical intervention for a client.
The Technology Acceptance Model (TAM), developed to describe technology use in the
general population, is relevant to discuss when considering the uptake and continued use
of EAT by people with cognitive impairments (Davis, 1989). Two main concepts in TAM
are perceived usefulness and the perceived ease of use that influence the attitude of the