Using a Handhelpd Computer as a Cognitive-Behavioral Tool, by Tony Gentry, PhD OTR/L

Dr. Gentry is a recognized expert in the field of assistive technology and cognitive prosthetics.  He recently shared this document with me, and generously granted permission for its distribution.

Intro-to-pda-as-cogaid Gentry 2014-07-28 perm to distribute

This paper answers important questions related to how and why products like Apple’s iPod and iPads and “the growing catalog of Android and Microsoft tablets” are becoming important devices for individuals with cognitive disabilities.  It also provides suggestions when trying to figure out “what to do first.”

  • Remembering to Do Things
  • Task-Sequencing and Wayfinding
  • Social Stories and Behavioral Cues
  • Stress Management
  • Academics, Healthy Living and Beyond

Dr. Gentry’s is the Director of the Assistive Technology for Cognition Laboratory at Virginia Commonwealth University.  His contact information is below:

Tony Gentry, PhD OTR/L
Associate Professor
Director, Assistive Technology for Cognition Laboratory
Department of Occupational Therapy
Virginia Commonwealth University
Room 2050
730 East Broad Street
Richmond, VA 23298

804-828-3397

Voice-to-text voicemail conversion

I use YouMail Visual Voicemail, and it works well for me.  It gives me quick VISUAL access to my voice mail messages.  I am told it increases productivity for many whose speed of processing is slower than it used to be. It also makes voice mail sort-able and See http://www.youmail.com/

 

“Clarify and Verify”

“Clarify and Verify” is perhaps one of the most POWERFUL compensatory skills (habits) an individual with cognitive inconveniences can practice.  It’s a common communication technique, but for anyone who is challenged with “mis-hearing,” “mis-remembering,” or other mis’s brain injury can cause this simple phrase often saves the day:

“Let me see if I heard you correctly.  You said (or asked me to) ___________________.  Is that right?”

Then write down the results (or speak the results into you iPad or other recording device). Not only is this good for you (the person asking for verification), it’s good for the person you are talking to.  It’s good for the relationship too.  The two-way communication “street” will be clear of clutter and misunderstanding.  And when others see you writing down the results, they will start to gain confidence that they are heard and you will know, if not remember, what was said and agreed upon. Employers are especially appreciative of this communication practice.  Don’t be surprised if they start using it, and asking others they work with to use it too!

Thank you Francis, for this valuable phrase.

Everything in ONE PLACE

To function at the level I wish to function, I need all the information I was once able to find in my head, organized in a way I can see it.  For me, that means that all the “bits” I need, have to be visually available and all in one place.  No easy task!

One way to have everything in one place for work tasks and projects is using multiple computer monitors.  Most people do not use this many., but after slowly adding one at a time, this is what I ended up with. For individuals with brain injury who have office jobs, one extra monitor is often helpful and two extra monitors are generally sufficient.  These also fall into the category of “reasonable accommodations.”

The reason all this because they make needed information visually available. I can alternate attention (“switch gears”) and maintain focus without struggle to do the impossible with my unreliable organic brain. Less stress. Less struggle.

Focus with multiple monitors

In days past, one of my most powerful visual resources for keeping “everything” in one place, was my (paper-based) BRAIN BOOK®, which was always open to the central “TODAY” page.  Tabs that organized all the important sections, flared out left and right (see below left).  Many of my students have made their own brain books, either with or without the masters we used for BRAIN BOOK® System.  Let me know if you want a list of the most helpful section headings or Masters for printing insert pages.

BBS Tabs as visual cues

Now my personal My Bionic Brain® does the same thing, but in key-word searchable electronic form on an iPad.  By keeping My Bionic Brain® open to the main TODAY screen, I have my primary visual cues in full view.  Reference Notes, documents, e-mails, TO DO Lists and scheduled tasks and appointments re never lost or “spaced.”  I call it my “BRAIN BOOK on steroids.” And yes, it sits on my desk next to me, along with all the monitors. ♥

For a PDF of the image below: TRI-FOLD brochure

Everything in One Place

Communication – Remembering what I want to say

Remembering  we want to say — when we need to have this information — can be challenging in the hustle and bustle of the workplace.  Remembering what was said, and by whom can be equally difficult.  In my experience, the solution is often to stop trying to remember these things. 

Instead, writing main points down is far more effective for KNOWING, if not remembering conversations with others.   I’d suggest recording conversations, but people don’t always like being recorded (some won’t permit it) and the retrieval process is cumbersome to boot.  I selectively record conversations these days.

In days gone past, I used “TALK TO” pages.  These were a staple in the BRAIN BOOK System, and they worked well.  A key person’s name would be written on the top of the page, and conversations would be tracked (hand written) as they happened.  This made for a lot of paper, writing was slow and retrieval was cumbersome.  But the “shell” was there with visual cues for making sure all the necessary bits could be retrieved. This strategy was better than not remembering or ascribing conversations to the wrong person. The image below is from the BRAIN BOOK System’s s”TALK TO” Section:

TALK TO image from BBS Work Manager

Subscribers to the blog who wish to use a master to make copies for these pages, are welcome to do so from the following:  TALK TO MASTER for printing

Fast forward to 2014:  Voice-to-text capability of the iPad, coupled with electronic “TALK TO” pages that are specially designed for individuals with memory challenges, make it possible to speak our notes and organize our thoughts by topics, or even exact wording for what we want to say (especially helpful if word-finding is an issue).  When results of conversations are entered (or SPOKEN), they are tracked, by person “talked to” and the software even writes a Reference Note that is key word searchable in the future.  The image below is from the My Bionic Brain “TALK TO” Section.  VALUABLE ASSISTIVE TECHNOLOGY FOR THE WORKPLACE!

TALK TO Screen from MyBionicBrain

Focus and Attention

Staying focused and having strategies for paying attention and alternating attention are important for many kinds of work situations. “Attention training” only goes so far.  We often gain more functional capacity for maintaing and alternating attention when we use visual cues — some can be simple, low-tech tactics like using “Focus (cue) Cards” (below left and/or background cues an individual keeps in sight (below right).  These items qualify as “assistive technology,” despite not being electronic.

      focus clip on desk                                Orientation work MBB screen

My work requires a great deal of alternating attention and “switching gears” — what with managing multiple projects, answering e-mails, teaching and answering the phone.  Multiple computer monitors save the day for me and many others I teach and coach, even if their jobs are not as complicated as mine.  Most people do not use this many monitors.  One extra monitor is often helpful and two extra monitors are generally sufficient.   The reason all these tools work is because they make needed information visually available.

Focus with multiple monitors

In days past, one of my most powerful visual resource was my BRAIN BOOK, which was always open to the central “TODAY page, with tabs that organized all my BRAIN BOOK sections, flaring out left and right (see below left).  Now my personal My Bionic Brain does the same thing, but in electronic form on an iPad.  By keeping My Bionic Brain open to the main “TODAY” screen, I have my primary visual cues (markers) in full view.   TO DO Lists and schedules tasks and appointments re never lost or “spaced.” All my Reference Notes are key word searchable.  Documents are all in one spot. . . I call it my “BRAIN BOOK on steroids.”

BBS Tabs as visual cues                     PIC LIB MBB Unscheduled TO DO List

Green ROUTINES

From the BRAIN BOOK® System

From the BRAIN BOOK® System

Managing recurring tasks and appointments is often challenging for individuals with brain injury — especially if things change.  You know, a routine staff meeting gets moved to a different day or time, or a standing appointment or meeting gets changed.  Not only can we forget routine tasks and appointments when we least expect it, we can easily become calcified in comfortable routines we have taken great pains to memorize.

A handy strategy is to use “green ROUTINES” cue cards (this rhyming supports memory). the idea is to keep track of routines and changes to then, in one place — on the card, but schedule FROM them once a week.

The following masters are for the use of subscribers to the Blog on the condition that they are copied only for your personal, non-commercial use. A green card stock is recommended.  After printing, trim them so they stack front-to-back, as illustrated above.

GREEN ROUTINES masters with instructionf for printing

My Bionic Brain® users have a much easier time of it in some respects, because there’s no more printing and writing.  That said, learning to schedule “green ROUTINES’ from the buttons on your iPad could take some getting used-to.  Drop me an e-mail if you need a quick GoToMeeting “refresher.”

SS CLEAN - ROUTINES BLANK ROUTINES

 

Compensatory Strategies and Employment

NIH banner    Most of my functional gains are because I learned early that I got the most bang for my buck cognitively, by compensating for the gaps and glitches my brain injury caused.  See this article from 1999. See the attached with highlighting added where I was quoted (page 7): “Many of my peers would be working too, if they had been given the opportunity to learn how to compensate.”   NIH article quoting Moeller from 1994 – emphasis added

The entire article is still on the internet at: http://www.nichd.nih.gov/publications/pubs/TBI_1999/Pages/Appendix_A.aspx

Fast forward to 2014:

If I were being quoted today, instead of saying “learn how to compensate” (which is difficult without the kind of cognitive rehabilitation I was fortunate to have), I would say it this way:

“Many of my peers would be working too if they had the specialized tools and work-focused skills training they need to be able to compensate.”

For those of us with cognitive disabilities, our strengths often lie in being visually cueable.  This, coupled with the residual strength of muscle memory (AKA “procedural memory”), as long as we have accessible visual cues we can reach for, we can level the playing field at home, at work and in our involvement in the community.

After working with hundreds of individuals over 20 years’ time, my research and experience has resulted in a commitment to producing a state-of-the art compensatory system — a cognitive prosthetic, if you will — complete with self-help skills training support and 24/7 support. “Knowing how to compensate” continues to be the key, in my view, to empowerment, cognitive mobility, and sustainable, long-term functional recovery from brain injury and other “cognitive inconveniences.” For a printable copy of the image below: TRI-FOLD brochure

Everything in One Place