NeuroRehabilitation - Volume 37, issue 3

Authors: Scherer, Marcia J. | Federici, Stefano

Article Type: Editorial

Abstract: This special issue focuses on assistive technologies for cognition/cognitive support technologies as well as the ways in which individuals are assessed and trained in their use. We provide eleven diverse articles that give information on products, why they are used and not used, and best professional practices in service provision. Our goal is to highlight a broad topic that has received limited research investigation and offer an insight into how different countries and programs are promoting access to and use of assistive technologies for cognition/cognitive support technologies

Keywords: Assistive technology devices, assistive technology services, cognitive support technologies, nonuse, abandonment, Matching Person and Technology Model, brain injury

DOI: 10.3233/NRE-151264

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 315-319, 2015

Authors: Federici, Stefano | Meloni, Fabio | Bracalenti, Marco | De Filippis, Maria Laura

Article Type: Review Article

Abstract: OBJECTIVE: This review examines the utility of current active, powered, wearable lower limb exoskeletons as aids to rehabilitation in paraplegic patients with gait disorders resulting from central nervous system lesions. METHODS: The PRISMA guidelines were used to review literature on the use of powered and active lower limb exoskeletons for neurorehabilitative training in paraplegic subjects retrieved in a search of the electronic databases PubMed, EBSCO, Web of Science, Scopus, ProQuest, and Google Scholar. RESULTS: We reviewed 27 studies published between 2001 and 2014, involving a total of 144 participants from the USA, Japan, Germany, Sweden, Israel, …Italy, and Spain. Seventy percent of the studies were experimental tests of safety or efficacy and 29% evaluated rehabilitative effectiveness through uncontrolled (22%) or controlled (7%) clinical trials. CONCLUSIONS: Exoskeletons provide a safe and practical method of neurorehabilitation which is not physically exhausting and makes minimal demands on working memory. It is easy to learn to use an exoskeleton and they increase mobility, improve functioning and reduce the risk of secondary injury by reinstating a more normal gait pattern. A limitation of the field is the lack of experimental methods for demonstrating the relative effectiveness of the exoskeleton in comparison with other rehabilitative techniques and technologies. Show more

Keywords: Powered active lower limb exoskeleton, paraplegic patients, gait disorders, central nervous system lesions, neurorehabilitation, systematic review, PRISMA

DOI: 10.3233/NRE-151265

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 321-340, 2015

Authors: Liberati, Giulia | Federici, Stefano | Pasqualotto, Emanuele

Article Type: Review Article

Abstract: BACKGROUND: Brain–computer interfaces (BCIs) allow persons with impaired mobility to communicate and interact with the environment, supporting goal-directed thinking and cognitive function. Ideally, a BCI should be able to recognize a user’s internal state and adapt to it in real-time, to improve interaction. OBJECTIVE: Our aim was to examine studies investigating the recognition of affective states from neurophysiological signals, evaluating how current achievements can be applied to improve BCIs. METHODS: Following the PRISMA guidelines, we performed a literature search using PubMed and ProQuest databases. We considered peer-reviewed research articles in English, focusing on the recognition of …emotions from neurophysiological signals in view of enhancing BCI use. RESULTS: Of the 526 identified records, 30 articles comprising 32 studies were eligible for review. Their analysis shows that the affective BCI field is developing, with a variety of combinations of neuroimaging techniques, selected neurophysiological features, and classification algorithms currently being tested. Nevertheless, there is a gap between laboratory experiments and their translation to everyday situations. CONCLUSIONS: BCI developers should focus on testing emotion classification with patients in ecological settings and in real-time, with more precise definitions of what they are investigating, and communicating results in a standardized way. Show more

Keywords: Affective brain computer interfaces (aBCI), brain state classification, assistive technology

DOI: 10.3233/NRE-151266

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 341-358, 2015

Authors: Leopold, Anne | Lourie, Anna | Petras, Hanno | Elias, Eileen

Article Type: Review Article

Abstract: BACKGROUND: Many individuals with traumatic brain injury (TBI) are young and could have many years of productivity ahead of them. However, cognitive impairments may hinder individuals’ ability to perform daily tasks. Assistive technology for cognition (ATC) can be effective in helping compensate for cognitive impairments. OBJECTIVE: This study examined the current state of the research on using ATCs to support daily activities for individuals with cognitive disabilities that are due to TBI. METHODS: A comprehensive systematic literature search was performed to identify peer-reviewed articles published between 2000 and 2015. To evaluate the nature of the research, …qualitative data were extracted pertaining to recruitment, participant characteristics, intervention design, type of ATCs and their functions, matching individuals with ATCs, training for using the ATC, and outcomes. RESULTS: Research examining the effectiveness of ATCs as everyday compensatory tools for cognitive impairments that are due to TBI is limited. The majority of studies were case studies or quasi-experimental studies with small sample sizes. Studies showed positive associations between use of ATCs and individuals’ abilities to perform tasks regardless of age, TBI severity, and time since injury. CONCLUSIONS: Future research should assess the match between the individual and the technology, study the impact of training on using ATCs, and analyze the usability of ATCs. Show more

Keywords: Traumatic brain injury, assistive technology for cognition, cognitive impairments, daily activities, literature review

DOI: 10.3233/NRE-151267

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 359-378, 2015

Authors: Adolfsson, Päivi | Lindstedt, Helena | Janeslätt, Gunnel

Article Type: Research Article

Abstract: BACKGROUND: People with cognitive disabilities have difficulties in accomplishing everyday tasks. Electronic planning devices (EPDs) may compensate for the gap between a person’s capacity and everyday challenges. However, the devices are not always used as intended. Despite that, cognitive assistive technology has been investigated in several studies, knowledge regarding when and what makes adults decide to use EPDs is incomplete. OBJECTIVE: The aim was to explore the subjective experiences of people with cognitive disabilities in relation to the use of EPDs. METHODS: A qualitative approach was applied with a qualitative content analysis. Twelve respondents were interviewed …with support from a study specific guide. RESULTS: A model representing the respondents’ experiences in the use of EPDs, comprising one theme, Possibility to master my daily life , four categories, Degree of fit to my needs, I am aware of my cognitive disability, I get help to structure my everyday life and The EPD improves my volition and ten subcategories, was developed. CONCLUSIONS: EPDs allow people with cognitive disabilities the possibility to deal with daily challenges; those who find EPDs beneficial tend to use them. EPDs can help people with cognitive disabilities in organisation, managing time and improve volition. Show more

Keywords: Procrastination, awareness of disability, volition, daily time management, cognitive assistive technology, qualitative analysis

DOI: 10.3233/NRE-151268

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 379-392, 2015

Authors: Lancioni, Giulio E. | Singh, Nirbhay N. | O’Reilly, Mark F. | Sigafoos, Jeff | D’Amico, Fiora | Buonocunto, Francesca | Navarro, Jorge | Lanzilotti, Crocifissa | Fiore, Piero | Megna, Marisa | Damiani, Sabino

Article Type: Research Article

Abstract: BACKGROUND: Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. OBJECTIVE: This study aimed to (a) further assess a technology-aided approach for fostering MCS participants’ responding and stimulation control and (b) carry out a social validation check about the approach. METHODS: Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods …of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. RESULTS: The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. CONCLUSIONS: A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable. Show more

Keywords: Assistive technology, minimally conscious state, stimulation control, social validation

DOI: 10.3233/NRE-151269

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 393-403, 2015

Authors: Bilancia, Giovanni | Marazzi, Moreno | Filippi, Davide

Article Type: Research Article

Abstract: BACKGROUND: Specific Learning Disorders (SLD) therefore represent chronic, not temporary disorders with varying degrees of expression throughout life. The beginning of imaging, anatomy and genetics studies have made it possible to investigate the brain organization of individuals suffering from SLD (Deheane, 2009). OBJECTIVES: The purpose of this paper is to describe a treatment method for reading and writing disorders through an intervention based on the integration of a sublexical method and a neuropsychological approach, with assistive technologies in the study of a single case. METHODS: The protocol is based on the modularization theory (Karmiloff-Smith, 1990). The …data presented in this paper with a A-B-A basic experimental drawing. RESULTS: This study confirms the degree of effectiveness of the treatments based on the automated identification of syllables and words together with the integrated enhancement of neuropsychological aspects such as visual attention and phonological loop (Benso, 2008), although in the follow-up condition only some abilities maintain the progress achieved. CONCLUSIONS: As previously mentioned, the SLD represents a chronic disorder, consequently the treatment does not solve the root cause of the problem, but can grant a use of the process decidedly more instrumental to everyday life. Show more

Keywords: Dyslexia, learning disorder, sublexical method, neuropsychological methods, tachistoscope software

DOI: 10.3233/NRE-151270

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 405-423, 2015

Authors: Leslie, Mykal | Kinyanjui, Benson | Bishop, Malachy | Rumrill Jr., Phillip D. | Roessler, Richard T.

Article Type: Research Article

Abstract: BACKGROUND: Cognitive symptoms and other functional limitations associated with multiple sclerosis (MS) have a significant negative impact on employment status. Work accommodations positively impact the ability of a person with MS to obtain and retain employment, however, current understanding of the role of accommodations in the careers of adults with MS is limited. OBJECTIVE: To analyze the percentage of American workers with MS who utilize workplace accommodations as per Title I of the ADA, the types of accommodations most frequently required, and differences in disease variables, job-related factors, and quality of life between workers using and not using …work accommodations. METHODS: Data from 746 employed adult members of the National MS Society surveyed about career concerns were analyzed. Descriptive and inferential statistics were used as appropriate to address the research questions. RESULTS: Approximately 25% reported having requested accommodations, and 87.7% reported receiving the requested accommodation. Participants with progressive MS, cognitive impairment, higher number of MS symptoms and greater symptom severity were more likely to use work accommodations. Participants with accommodations reported poorer job match and career optimism than those using no accommodations. CONCLUSION: This large-scale analysis addresses several outstanding questions concerning work accommodations among workers with MS. Cognitive symptoms and disease severity are strongly associated with need for accommodations, however accommodations do not appear to promote job satisfaction or longevity. The accommodation request process and the impact of accommodations on employment retention remain important research foci. Show more

Keywords: Multiple sclerosis, employment accommodations, cognitive symptoms, job retention

DOI: 10.3233/NRE-151271

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 425-436, 2015

Authors: Powell, Laurie E. | Glang, Ann | Pinkelman, Sarah | Albin, Richard | Harwick, Robin | Ettel, Deborah | Wild, Michelle R.

Article Type: Research Article

Abstract: BACKGROUND: Assistive technology for cognition (ATC) can be an effective means of compensating for cognitive impairments following acquired brain injury. Systematic instruction is an evidence-based approach to training a variety of skills and strategies, including the use of ATC. OBJECTIVE: This study experimentally evaluated systematic instruction applied to assistive technology for cognition (ATC) in a vocational setting. METHODS: The study used a single-case, multiple-probe design across behaviors design. The participant was a 50-year old female with cognitive impairments following an acquired brain injury (ABI). As a part-time employee, she was systematically instructed on how to operate …and routinely use selected applications (apps) on her iPod Touch to support three work-related skills: (a) recording/recalling the details of work assignments, (b) recording/recalling work-related meetings and conversations, and (c) recording/performing multi-step technology tasks. The experimental intervention was systematic instruction applied to ATC. The dependent measures were: (a) the use of ATC at work as measured by an ATC routine task analysis; and (b) recall of work-related tasks and information. RESULTS: Treatment effects were replicated across the three work-related skills and were maintained up to one year following the completion of intensive training across behaviors with periodic review (booster sessions). CONCLUSIONS: Systematic instruction is a critical component to teaching the routine use of ATC to compensate for cognitive impairments following ABI. Show more

Keywords: Employment, vocational rehabilitation, brain injury, assistive technology, cognitive support technology, cognition, generalization, transfer of learning, systematic instruction, errorless learning

DOI: 10.3233/NRE-151272

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 437-447, 2015

Authors: Hendricks, Deborah J. | Sampson, Elaine | Rumrill, Phillip | Leopold, Anne | Elias, Eileen | Jacobs, Karen | Nardone, Amanda | Scherer, Marcia | Stauffer, Callista

Article Type: Research Article

Abstract: BACKGROUND: This article describes the activities and interim outcomes of a multi-site development project called Project Career, designed to promote cognitive support technology (CST) use and employment success for college and university students with traumatic brain injuries (TBIs). OBJECTIVES: To obtain early intervention results from participants in Project Career’s first 18 months of operation. METHODS: Fifty-six students with TBI have participated to date across three implementation sites in Massachusetts, Ohio, and West Virginia, with 25 of these participants being military veterans. Descriptive analyses provide information regarding the participants, the barriers they face due to their TBI …in obtaining a post-secondary education, and the impact services provided by Project Career have had to date in ameliorating those difficulties. Inferential statistical analyses provide preliminary results regarding program effectiveness. RESULTS: Preliminary results indicate the program is encouraging students to use CST strategies in the form of iPads and cognitive enhancement applications (also known as ‘apps’). Significant results indicate participants are more positive, independent, and social; participants have a more positive attitude toward technology after six months in the program; and participants reported significantly improved experiences with technology during their first six months in the program. CONCLUSION: Participating students are actively preparing for their careers after graduation through a wide range of intensive vocational supports provided by project staff members. Show more

Keywords: Cognitive support technology, traumatic brain injury

DOI: 10.3233/NRE-151273

Citation: NeuroRehabilitation, vol. 37, no. 3, pp. 449-458, 2015