Page 58 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 45

Much assistive technology that has been developed to help people with cognitive
impairment has focused on the compensation of impairments to increase functional inde-
pendence. Some researchers and clinicians have questioned whether or not this is appro-
priate for certain groups. For example, the critical dementia perspective questions the
aim of attempting to compensate for impairments in the face of declining cognitive abili-
ties, which fundamentally alter the person’s place in the world. It is claimed that research
into interventions to restore function after dementia place a great deal of importance on
cognitive ability and suggest that we should look beyond cognitive ability when thinking
about how individuals with dementia contribute toward society. One paper detailed how
assistive and supporting technologies might be designed from this perspective, giving the
example of an art project during which a person with severe dementia was filmed creating
an artwork. The purpose was not to improve her cognitive or functional abilities, but to
allow family members to connect with her and gain a deeper understanding of her experi-
ences (Lazar et al., 2015). It is also true that in neurorehabilitation there is often a focus
on the cognitive domains that clinical interventions can improve. As mentioned in the
previous section, designers should be careful when developing ‘one-size-fits-all’ solutions
that lack personalisation and refrain from offering interventions to clients prior to their
readiness for neurorehablitation. There is a place for technology that aims to help people
retain, compensate for or retrain cognitive and physical abilities affected by developmen-
tal, acquired or progressive neurocognitive impairment. However, clinicians and research-
ers should think critically about who and what EAT is for.
Further ethical considerations have been voiced by participants in research studies,
especially when covering topics of remote sensing, covert data collection and the reduced
or declining capacity for the individual to consent (van den Heuvel et al., 2012; Zwijsen et al.,
2011; McGee-Lennon et al., 2011). There are a number of conflicting issues, such as safety
versus privacy when introducing sensing technologies into dementia care, or between
encouraging autonomy in medical care versus ensuring that medication is taken at the right
time. For example, prompting technology might be able to prompt somebody to take medi-
cation on time, but this could be dangerous if this technology stops working and people
have not developed the skills to self-medicate, and do not have carers who can help.
The ethical issues explored in this research are important when considering both the
design and the clinical provision of EAT. It is an area that highlights the need for a multidis-
ciplinary approach, in which the needs and desires of potential stakeholders are factored
into the design of technologies. Without this, we risk prescribing EAT that is not useful and
may be unethical.

Conclusions

Cognitive impairment must be taken into account when using EAT to help patients live
independently and safely.
In this chapter we described the characteristics and course of different forms of cogni-
tive impairment and discussed the impact that impairment in specific cognitive domains