Page 54 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 41

use, McGee-Lennon et al. (2012, p. 11) reported that ‘Technologies are often perceived
as acceptable only when they offer a noticeable benefit to the user.’ Caregivers commu-
nicated that technologies are often prescribed to the users without justification or expla-
nation of their potential benefits. Studies with people with brain injury have shown that
people must experience the effects of their impairment before feeling the motivation to
engage with EAT (Baldwin et al., 2011; Jamieson et al., 2015). This can often be an issue if
people are highly supported to perform everyday tasks and may not see the full need for
EAT until that support is removed. This can be a particular problem in neurorehabilita-
tion when an individual transitions between intensive inpatient care and less intensive
community support because the intensive care environment is the ideal setting to intro-
duce, train and tailor the EAT intervention. However, because of the high level of support
in this environment, the individual may not see the need for the technology until after
they move into community care, and so may not engage with the technology while in the
rehabilitation unit.
This issue is particularly relevant for people with cognitive impairments because they
may have poor self-awareness of the difficulties that make the technology necessary. For
example, in an in situ study with people with severe memory impairments living in a reha-
bilitation centre, participants reported not needing a mobile phone reminder even when
staff reported that they forgot to do a number of important everyday activities (Jamieson
et al., 2017). One solution to this problem might be to illustrate the benefits of using the
technology. For example, a caregiver speaking in a focus group about smartphone reminder
apps for memory impairment (Jamieson, 2016, p. 118) said that they used a memory aid
on a smartphone and thought this might influence their family member with brain injury:
‘I think initially we’d be quite happy to use that. I think it would introduce again that curi-
osity you see where he’d eventually ask – how did you do that? I’d like to do that myself. So
yeah I think it would be good way in to introduce it to carers who show how to do it and
then it gets passed along…’
In neuropsychological rehabilitation, one of the roles of the clinician is to help some-
body see the need for rehabilitation and become ready to engage in an intervention (Van
den Broek, 2005; Wilson, 2009). This is contrasted with introducing an intervention as
soon as rehabilitation is available to the client, regardless of whether or not they desire or
see the need for that intervention. It has been claimed that this is one of the key reasons
why neurorehabilitation sometimes fails (Van den Broek, 2005), and this is likely also to be
the case for the introduction of EAT.

Frame of Reference and Stigma

Another theme that has been described consistently in studies garnering the opinions of
EAT stakeholders is the stigma that using technology can bring. For example, people with
cognitive impairments from different aetiologies have stated that they did not want other
people to see them using assistive technology for fear that they would think badly of them
(Baldwin et al., 2011; Dawe, 2006; Bharucha et al., 2009).