Development and Evaluation of an Assistive Prompting System for People with Traumatic Brain Injury

Cognitive deficits in executive functioning are among the most frequent sequelae after traumatic brain injury (TBI) at all levels of severity. Due to these functional deficits in cognition, individuals with TBI often experience difficulties in performing instrumental activities of daily living (IADL), especially those IADLs that involve a sequence of goal-directed actions. We obtained updated information on the use of assistive technology for cognition (ATC) through a survey study among twenty-nine participants with TBI. Results highlighted the needs to support the development and evaluation of ATC in assisting multi-step tasks. Cooking tasks were selected as a representative for they are cognitively demanding and have been identified essential for living independently. With the recent advance in sensing and smart home technologies, it’s possible to provide context-aware prompts with minimal user inputs. However, limited information is known regarding what types of context-aware prompts are really needed by people with TBI in completing cooking tasks. We compared the effectiveness and usability of current available prompting methods (e.g. paper-based prompting method and user-controlled method) among ten individuals with TBI in their home kitchens. We categorized the nature of problems faced by end-users with both prompting methods in cooking tasks and proposed relevant context-aware solutions. A test-bed Cueing Kitchen with sensing and prompting elements was developed to address these identified needs and to evaluate the feasibility of context-aware ATC interventions in assisting people with TBI with kitchen activities. Sixteen individuals with TBI participated in the study. Results showed that comparing to the conventional user-controlled method, the automatic method decreased the amount of external assistance required by participants, received higher ratings in perceived ease-of-use, and was helpful for decreasing user stress levels. However, the user-controlled method showed strengths in offering participants more flexibility and control on the timing of prompts. The contributions from this dissertation not only developed a context-aware prompting testbed and evaluated the feasibility of an automatic system, but also advanced the guidelines and potential solutions for future development of assistive prompting technology for people with cognitive impairments in sequential tasks

Accessible Ubiquitous Services for Supporting Daily Activities: A Case Study with Young Adults with Intellectual Disabilities

Ubiquitous environments have considerable potential to provide services supporting daily activities (using public transportation to and from workplace, using ATM machines, selecting and purchasing goods in ticketing or vending machines, etc.) in order to assist people with disabilities. Nevertheless, the ubiquitous service providers generally supply generic user interfaces which are not usually accessible for all potential end users. In this article, a case study to verify the adequacy of the user interfaces automatically generated by the Egoki system for two supporting ubiquitous services adapted to young adults with moderate intellectual disabilities was presented. The task completion times and the level of assistance required by participants when using the interfaces were analyzed. Participants were able to access services through a tablet and successfully complete the tasks, regardless of their level of expertise and familiarity with the service. Moreover, results indicate that their performance and confidence improved with practice, as they required fewer direct verbal and pointer cues to accomplish tasks. By applying observational methods during the experimental sessions, several potential improvements for the automated interface generation process were also detected.This research work was supported by the Ministry of Economy and Competitiveness of the Spanish Government and by the European Regional Development Fund [projects TIN2014-52665-C2-1-R and TIN2017-85409-P], and by the Basque Government, Department of Education, Universities and Research under grant [IT980-16]

Choice Making and Individuals with Significant Disabilities

This literature review addresses issues and trends pertaining to choice making for individuals with significant disabilities. The benefits and development of choice making will be addressed, followed by a summary of several barriers to choice making. The review concludes with a synthesis of strategies and interventions for increasing effective choice-making opportunities, including choice-making formats, teaching choice making, and building choice making into daily contexts

Programa AQRDATE aplicado en rehabilitación en actividades de la vida diaria en pacientes con daño cerebral adquirido

Versión electrónica de la ponencia presentada en INTERA 2011: International Technology Robotics Applications Congress, celebrado en Mieres en 2011El proyecto que proponemos consiste en la utilización de un dispositivo móvil que facilite la realización de las Actividades de la Vida Diaria (AVD) en personas que han sufrido un daño cerebral adquirido. Estas dejan de realizarlas con autonomía debido a una alteración en las funciones mentales superiores (atención, funciones ejecutivas,…). Para conseguir la funcionalidad propuesta se combinan etiquetas 2D en las cuales se almacena la información (análisis de tareas de las AVD) con un teléfono móvil. Las tareas que se han seleccionado son: hacer un zumo de naranja, preparar un café con leche, preparar dos tostadas y untarlas con mantequilla y mermelada. Estas se han subdivido en subtareas que se irán mostrando en la pantalla del teléfono móvil de forma secuenciada, lo cual permitirá al usuario acceder a la información. El sistema por lo tanto ofrece al usuario la posibilidad de: planificar, organizar, secuenciar y ejecutar la actividad propuest

The Impact of a School-to-Work Transition Program on Self-Determination of Young Adults with a Diagnosis of Autism Spectrum Disorder

The purpose of this study was to examine the impact of participation in a school-to-work transition program on self-determination of young adults diagnosed with autism spectrum disorders (ASD). Five young adults between the ages of 18 and 22 with a diagnosis of ASD were the focus of the study. The young adults participated in a university-based Project SEARCH (PS) school-to-work transition program. The program provided the students with internship opportunities in custodial service, food service, laundry service, computer and technology lab, and office administration. A basic qualitative research design was used to examine the experiences of the five students in PS. Field observations, interviews, and archival program documents were used as data sources for the study. PS staff members, internship supervisors and mentors, and parents/guardians of the young adults and the students were interviewed. Grounded theory techniques were employed to develop four major categories from the data. The categories covered the data in exhaustive ways that describe and explain changes in self-determination and factors that influence it. Results of the study showed evidence of positive changes in specific aspects of self-determination. Self-determination was supported by environmental contexts and deliberate efforts that aimed to enhance student capacity to act self-determined. Self-determination was undermined by factors that hindered opportunities for students to maximize learning of new skills. Unique to this study, findings suggest that, changes in routines and setting undermined the students’ capacity to demonstrate autonomy or behavior and emotional regulation. Limitations and suggestions for future research are also presented

MindMate: a single case experimental design study of a reminder system for people with dementia

Background: Prospective memory difficulties are commonly reported in people with dementia. The evidence supporting the use of prospective memory devices among the dementia population remains limited. MindMate is a recently developed smart device application that aims to support individuals with a diagnosis of dementia, improving self-management skills and quality of life. Aims: This study investigated the effectiveness and usability of the reminder tool on the MindMate application as a memory aid. Method: Three participants with a diagnosis of mild Alzheimer’s disease were recruited to this multiple baseline single case experimental design study. Partners of the participants recorded their performance on everyday tasks on weekly monitoring forms during a baseline phase (for between five and seven weeks) and during the intervention phase (five weeks) whilst using MindMate. Results: Two participants successfully used the app throughout the intervention weeks and gave positive usability ratings. Tau-U analysis showed a significant increase in memory performance between baseline and intervention phase (Tau-U = 1, 0.94, p<0.01). A third participant withdrew from the intervention phase following difficulties turning off the reminders and frustrations with the reminder alert sound. Conclusions: The use of the MindMate app was feasible for people with dementia in the community. It was effective compared to practice as usual, with participants reporting intentions to use in the future. Limitations and implications for future research are discussed

Investigating assistive technology to support memory for people with cognitive impairments

Technologies such as automobiles or mobile phones allow us to perform beyond our physical capabilities and travel faster or communicate over long distances. Technologies such as computers and calculators can also help us perform beyond our mental capabilities by storing and manipulating information that we would be unable to process or remember. In recent years there has been a growing interest in assistive technology for cognition (ATC) which can help people compensate for cognitive impairments. The aim of this thesis was to investigate ATC for memory to help people with memory difficulties which impacts independent functioning during everyday life. Chapter one argues that using both neuropsychological and human computing interaction theory and approaches is crucial when developing and researching ATC. Chapter two describes a systematic review and meta-analysis of studies which tested technology to aid memory for groups with ABI, stroke or degenerative disease. Good evidence was found supporting the efficacy of prompting devices which remind the user about a future intention at a set time. Chapter three looks at the prevalence of technologies and memory aids in current use by people with ABI and dementia and the factors that predicted this use. Pre-morbid use of technology, current use of non-tech aids and strategies and age (ABI group only) were the best predictors of this use. Based on the results, chapter four focuses on mobile phone based reminders for people with ABI. Focus groups were held with people with memory impairments after ABI and ABI caregivers (N=12) which discussed the barriers to uptake of mobile phone based reminding. Thematic analysis revealed six key themes that impact uptake of reminder apps; Perceived Need, Social Acceptability, Experience/Expectation, Desired Content and Functions, Cognitive Accessibility and Sensory/Motor Accessibility. The Perceived need theme described the difficulties with insight, motivation and memory which can prevent people from initially setting reminders on a smartphone. Chapter five investigates the efficacy and acceptability of unsolicited prompts (UPs) from a smartphone app (ForgetMeNot) to encourage people with ABI to set reminders. A single-case experimental design study evaluated use of the app over four weeks by three people with severe ABI living in a post-acute rehabilitation hospital. When six UPs were presented through the day from ForgetMeNot, daily reminder-setting and daily memory task completion increased compared to when using the app without the UPs. Chapter six investigates another barrier from chapter 4 – cognitive and sensory accessibility. A study is reported which shows that an app with ‘decision tree’ interface design (ApplTree) leads to more accurate reminder setting performance with no compromise of speed or independence (amount of guidance required) for people with ABI (n=14) compared to a calendar based interface. Chapter seven investigates the efficacy of a wearable reminding device (smartwatch) as a tool for delivering reminders set on a smartphone. Four community dwelling participants with memory difficulties following ABI were included in an ABA single case experimental design study. Three of the participants successfully used the smartwatch throughout the intervention weeks and these participants gave positive usability ratings. Two participants showed improved memory performance when using the smartwatch and all participants had marked decline in memory performance when the technology was removed. Chapter eight is a discussion which highlights the implications of these results for clinicians, researchers and designers

Promoting Self-Determination Skills of Individuals with Intellectual Disabilities Participating in the Inclusive Concurrent Enrollment Initiative Programs throughout Massachusetts

There are currently 15 Inclusive Concurrent Enrollment Initiative (ICEI) Programs throughout Massachusetts. Each program is different in its day-to-day planning but all adhere to the mission, full inclusion of students with intellectual and developmental disabilities. The purpose of this evaluative research study was to examine and understand the functional components of postsecondary education programs that promote self-determination for students with intellectual and developmental disabilities and to differentiate programs that include or do not include these components. To answer the five research questions data were collected from Students, Educational Coaches, ICEI Program Coordinators, Transition Liaisons, Statewide Coordinator, observations, and record reviews. To answer all the questions, it required integrating what we have learned about the program participants with what we are observing in the program. All of this information provided evidence to understand participant perceptions of the observed programs. All of the information collected was interpreted through qualitative and quantitative approaches consistent with the CIPP model. In addition to examining the quality and potential efficacy of program components, I also examined the consistency across programs. For instance, it was important to know if certain components were viewed as effective components across programs, while other components were viewed as being less effective across programs. These consistencies helped me to understand how the statewide support of specific programs may be adequately or inadequately supporting implementation of those components. Recommendations for program improvement activities to promote self-determinations skills, knowledge, and beliefs of students and educators are provided based on all of the data collected throughout the evaluation

EFFECTS OF THE SELF- DETERMINED LEARNING MODEL OF INSTRUCTION ON GOAL ATTAINMENT AND SELF-DETERMINATION FOR STUDENTS WITH AUTISM SPECTRUM DISORDER.

Even with current transition practice and service delivery requirements mandated for students with disabilities by the Individuals with Disabilities Education Act (IDEA, 2004) participation in postsecondary education and employment for individuals with autism remains low (Shattuck et al., 2012; Newman, Wagner, Cameto, & Knokey, 2011). The purpose of this study was to determine the effects of the Self-Determined Learning Model of Instruction (SDLMI; Wehmeyer, Palmer, Agran, Mithaug, & Martin, 2000). The intervention was designed to facilitate student development, and participation in community college course settings, increase academic and vocational goal attainment and self-determined behavior while decreasing support needs. The SDLMI has been shown to be effective for teaching students with disabilities how to access the general education curriculum and increase self-determination skills to achieve academic and vocational goals. A multiple probe design across participants with four college-aged students with autism evaluated the effects of the intervention for three different postsecondary education goals. Study findings show the extent to which the intervention affects participants’ ability to be more self-determined in their decision-making regarding the management of postsecondary educational goals and course requirements using self-directed learning. The SDLMI Teacher’s Guide for Model Implementation (Shogren, Wehmeyer, Burke, & Palmer, 2017) and teacher-facilitated procedures (National Technical Assistance Center on Transition, 2017) were used to ensure intervention implementation fidelity. The researcher and trained research assistant compared real time data in point-by-point agreement ratios to quantify the number of times the observers agreed about what they saw in each observation to determine differences during data collection. The baseline, intervention, and maintenance sessions lasted 13 weeks, and data were collected during all sessions. Results from the intervention effects showed a functional relationship (cause-effect) between the intervention and goal attainment. Participants increased their ability to use self-determined behaviors to attain goals through student questions, teacher objectives, and educational supports. Self-determined behaviors increased while support needs greatly decreased. Social validity data were collected through student self-monitoring using goal attainment scaling and parent perspectives to inform support intensity results. Factors related to self-determination, motivation, and expectations for future goals contribute to a better understanding of goal attainment through this research

Work-based Learning Experiences and Students with Intellectual Disabilities: A Qualitative Case Study

The purpose of this embedded single-case study was to understand how participation in work-based learning experiences (WBLE) prepares students with intellectual disabilities (ID) for successful post-school competitive employment. The theory guiding this study was Kolb’s experiential learning theory, as it systematically explains the four stages of learning that learners go through during WBLE. This embedded single-case study investigated the experience of 12 work site supervisors supervising students with an ID while participating in WBLE at a restaurant and a hotel and one student who participated in the WBLE. Data were collected using individual interviews, document analysis, and focus groups. The data analysis methods included spreadsheet software, in-vivo coding, and the development of themes. The themes discovered in this study were: Connect the Pieces for Mutual Gain, Student Willingness to Participate Outweighs their Disabilities, Teamwork in a Controlled and Supportive Environment, and Students Deal Confidently with Undesirable Situations and Tasks. The themes suggest that implementing WBLE for students with ID must include profound collaboration. Students with disabilities (SWD) are incredibly complex, as are the work environments in which they participate. SWDs have medical conditions that require attention, learning differences that necessitate accommodation, and limitations that demand consideration. In prioritizing the students\u27 vocational benefits and employability growth when implementing WBLE, all stakeholders profit from these extraordinary experiences