Page 56 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 43

and feel that ‘tech is just not me’ (Baldwin et al., 2011; Rosenberg et al., 2012; Hammel
et al., 2015). It could be difficult to introduce technology to people with this belief and it
may be that an alternative way of intervention or support can be found. Conversely, keep-
ing up with new technology can be important. In case of those with dementia supporting
the continued use of technology has been reported to be important to allow them to main-
tain their self-image (Rosenberg et al., 2012). Furthermore, integrating technology use
with existing habits is crucial for acceptance from people with dementia (Rosenberg et al.,
2012) and personalising technology based on preferences is important for acceptance of
technology from healthy older users (McGee-Lennon et al., 2011). However, it should be
noted that some older users also felt that personal preference should be overruled by care
needs if required (Clark and McGee-Lennon, 2011).
As well as being personal to patients’ attitudes and care needs, technology has to fit
unobtrusively into people’s lives to be accepted. This requirement places as much impor-
tance on the technology fitting into the user’s sense of self, and internal monologue about
their life and difficulties, as it does on functional utility. Researchers that have reported
this requirement draw a distinction between somebody being given a tool and told how
to use it, and discovering something for themselves, or even appropriating a tool for their
needs even when it was not originally meant for that purpose (McGee-Lennon et al., 2011;
Imperatore and Dunlop, 2015).
Encouraging and building this self-autonomy may actually be a crucial advantage of
technology because using technology as a tool to help independence may make one feel
more autonomous than if the exact same support was coming from a human. Contrast
the feelings of having a navigating passenger, often linked to the negative term ‘back-seat
driver’, with using a sat-nav to navigate in a car. While we would say that we found our
destination with the help of the navigator when it was a human in that role, it would be
rare to acknowledge the sat-nav in the same way; it is seen as a tool that helped us do the
job independently. Indeed, verbal prompting has been found to be a frequent antecedent
to aggressive behaviour (Alderman et al., 1997). An illustrative example of this in clinical
care has been communicated to one of the authors of this chapter (MJ) in a study that is
ongoing. An occupational therapist described the use of mobile phone texts to prompt a
client with memory and executive functioning difficulties following a brain injury.

He didn’t like when we prompted his self-care. He hated when his family prompted him.
So his brother set up the messages and sent them. His brother would send the messages
and change them every so often but he didn’t know where they were coming from…so
it took away that external pressure of a therapist telling you to do it, a support worker
telling you to do it, a family member telling you to do it – it was just a reminder. That
worked well because he’d come out and say, ‘oh my phone told me to do this!’

The issue of personalisation of technology to fit with the desires and needs of cli-
ents is important for people with cognitive impairment because there is huge vari-
ability between people with different disorders and within groups with the same