Mobile Technologies Nag You Toward Independence

By Tony Gentry, Ph.D., OTR/L, Virginia Commonwealth University

“Since your brain injury, what do people have to nag you to get done?”

This is the first question I ask when assessing whether a mobile technology may support an individual’s everyday living after a brain injury. Typical impairments in memory, planning, task-sequencing, and time management often lead caregivers and family members to become naggers, nudging a person along to stay on task just to get through the day. A mobile device and a well-chosen application (app)* or two can do that job, so the person with a brain injury can rely on the device to do the nagging instead. Nobody likes to be a nag and nobody likes a nagger. Letting a phone or tablet do the work can be a win-win for all!

Support for Everyday Memory

Since the first PalmPilot personal organizer was launched in the 1990s, pocket-sized devices have offered reminder calendars that flash or ring to help people remember appointments and activities. Today, all smart phones come with that capability, and there are also hundreds of reminder apps* available for download. Many people with memory impairments rely on alarm reminders – as many as 20 or more each day – to help them stay on task and attend appointments. Specialized medication management apps, such as My Pillbox and Medisafe, remind people to take their medications on time, show pictures of the correct pill, and offer check boxes for people who might forget that they’ve already taken their medications.

Support for Task-Sequencing

Many people need help performing complex activities, such as meal preparation, wayfinding in the community, interacting with others, and vocational tasks. Fortunately, there are various instructional slide show and video apps* that help users create step-by-step guides for their daily tasks that previously may have required supervision. The Can Plan and Function Planning System apps, for instance, use the phone’s camera to record a brief instructional video demonstrating how to perform a task. The video can be linked to a calendar reminder inside the app, so the video pops up along with the reminder alert exactly when the user needs instruction or assistance. When building a slide show or video for a user, it’s important to provide the right level of support. These apps allow one to easily produce photographic slide shows that may include audio, video, and/or text instructions. Some users only need text-based instructions while others prefer audio cues. With these apps, instructional materials can be customized to the user’s real needs.

When it’s time for users to perform a given task, a tried-and-true three-step instructional method called video modeling is recommended. Users can play slide shows or videos on a mobile device all the way through before attempting to complete tasks. While performing tasks, users can play and pause the material as needed. After completing tasks, users can play the instructional material again to compare what they did to what was shown on the slides or in the video. With repetition, this stepwise Preview/Play and Pause/Review model can help build competence while also providing in-hand support for task completion.

Behavioral Supports

Life after a brain injury can be confusing, leading to anxiety, loss of sleep, and various behavioral challenges. Fortunately, there are apps* that can help. Many people rely on relaxation apps, such as Breathe2Relax, Calm, or Simply Being, to help them pause, take a few deeps breaths, and get on with their day when anxiety strikes.

Doctor and therapy appointments can be frustrating for people with memory impairments. It can be hard to generate a useful answer when a health professional asks, “How have you been this past month?” Apps* such as MoodTracker and My Pain Diary can help. They can be set to remind a user to tap brief responses to health-related questions in real time, several times a day. The answers are saved in graphic form on the app, so users can illustrate their day-to-day experiences in a meaningful way. This information can help providers adjust medications and therapies more effectively.

Support for Speech Difficulties

Some people with brain injury suffer from dysarthria, making communication difficult. In the past, speech-generating devices could cost thousands of dollars, but now apps* such as Speakit! ($1.99) and Voice4u ($59) allow people to type phrases into their phones or tablets that can then be spoken out loud by the device. Two public speakers with brain injury of my acquaintance use the Speakit! app and an iPad to deliver their speeches! They enter typed content into the app, connect a portable speaker to their iPads, and simply tap to play back the spoken words. Speakit! has a selection of surprisingly natural-sounding speaking voices in both male and female registers.

Drinking from a Fire Hose

The great challenge in using mobile devices as everyday supports for brain injury is selecting and measuring the usefulness of the millions of apps* on the market. How do you choose? Overloading a phone with a lot of apps can make it confusing and difficult to use, and the device becomes ineffective. I urge people to select no more than three or four apps to support their everyday activities (see my favorites listed on page 13). For most, these include a good reminder app, an app to support list-making and task-sequencing, and a relaxation app for managing anxiety and stress. Some may require additional specialized apps for medication management or speech generation.

It may seem odd that only three or four apps* can support someone with brain injury, but the important thing to remember is that each app will be used quite often. For instance, a person may record up to 10-20 daily reminders in one app and have a second app for short instructional videos that support task management and wayfinding. Because the reminder and instructional apps recommended here are timed and self-generating, the user doesn’t have to navigate the screen to find them – the elements pop up when needed.

Who Programs These Things?

Occupational therapists (OTs) and speech and language pathologists (SLPs) can provide skilled assessment and focused interventions using mobile devices and apps*. OTs are trained to support everyday functional activities and assistive technology adaptations; SLPs address speech and cognition issues related to communication. Once trained to use a device, some people can program reminders and other cues themselves; others need a caregiver to set up the applications. For therapists involved in these interactions, it is important to collaborate with both the client and a caregiver while providing follow-along assistance and training as needs and solutions evolve.

Though mobile technologies cannot address all of the challenges people with brain injuries face, they can be useful tools to help people navigate difficulties in their everyday lives. Among other benefits, they help with remembering to do routine things, performing complex tasks, managing stress, and communicating effectively. Apps* are valuable in that they can support individuals who have been injured while taking the burden of nagging away from weary caregivers.

Online Resources

1. Assistive Technology for Cognition Facebook page
2. Dr. Gentry’s Assistive Technology for Cognition Laboratory at Virginia Commonwealth University