Assistive technology aims to improve the functional capabilities of people with disabilities or cognitive impairments. As the population ages, cognitive assistive technologies and cognitive rehabilitation interventions become increasingly important. Cognitive enhancement therapy combines computer-based cognitive training with group therapy to improve functions like attention, memory, and problem solving. Neuromodulation techniques combined with cognitive enhancement therapy may prolong the effects. Neuroplasticity enables the brain to compensate for injury and disease through new connections formed via experience-dependent rehabilitation programs. Both low-tech and high-tech memory aids can be used.

1. Assistive Cognitive Technology
Vivek Misra | B.Tech, M.S, MIANS
Chief Ideator
Uberbrain Brain Research Frontier
vivek@ubrf.org | @iVivekMisra
http://www.ubrf.org

2. Why ?
“Today, approximately 10 percent of the world's
population is over the age of 60; by 2050 this
proportion will have more than doubled. “
Moreover, the greatest rate of increase is amongst the "oldest old," people
aged 85 and over. While many older adults remain healthy and productive,
overall this segment of the population is subject to physical and cognitive
impairment at higher rates than younger people.

4. What Is Assistive Technology ?
Assistive technology (AT) is any item, piece of equipment, software
program, or product system that is used to increase, maintain, or improve
the functional capabilities of persons with disabilities.
At its core, AT is aimed to improve the environmental factors of the WHO –
ICF based checklist / assessment.
The terms “cognitive orthoses” and “cognitive prosthetics” are used
interchangeably and are defined as compensatory strategies that alter the
patient’s environment and are directed to an individual’s functional skills (1).
Kirsch NL, Levine SP, Fallon-Krueger M, Jaros LA. Focus on clinical research. The Journal of Head Trauma
Rehabilitation. 1987;2(4):77-86.

5. Cognitive Prosthetic
Cole (2) expanded this definition to include the following
attributes of a cognitive prosthetic:
• Uses computer technology
• Is designed specifically for rehabilitation purposes;
• Directly assists the individual in performing some of his/her
everyday activities;
• Is highly customizable to the needs of the individual.
Cole E. Cognitive prosthetics: an overview to a method of treatment. NeuroRehabilitation. 1999;12(1):39-
51.

6. Cognitive Rehabilitation Intervention
The aim of treatment is to improve the person’s ability to carry
out everyday tasks.
The process includes
Educating about the dementia and how and why it effects them
in that way
Re-establishment of direct skills through direct retraining.
Use of compensatory strategies and external aids

7. Cognitive Enhancement Therapy
Cognitive Enhancement Therapy (CET) is a holistic, integrated program for
treating the cognitive and psycho-social impairments found in range of
neuropsychiatric condition particularly in schizophrenia, bipolar disorder,
serious depression, some forms of autism and attention deficit hyperactivity
disorder (ADHD), dementia and movement disorder.
CET uses a combination of medicines, computer-based exercises, and group
therapy to treat.
Along with coaching and group treatment experiences, CET includes a
computer-based cognitive training module designed to improve core
cognitive functioning in areas of attention, memory, problem solving, visuo-
spatial tasks and social cognition (e.g. being able to take others’
perspectives, cognitive flexibility, getting the gist)

8. How ?
CET is a psychosocial cognitive remediation
intervention (3) that integrates 60 h of
computer-based training with 45 structured
social-cognitive group sessions designed to
improve abilities, such as perspective taking,
social context appraisal, and emotion
regulation abilities.
Examination of the neurobiological
underpinnings of improved emotion
regulation associated with cognitive
remediation can yield important information
about the plasticity of neural mechanisms
that can support recovery in this population.
(4) Hogarty G, Greenwald DP. Cognitive Enhancement Therapy: the Training Manual; 2006.
Hogarty GE, Greenwald DP, Eack SM. 2006 Dec;57(12):1751–7.

9. Neuromodulation
By understanding the basic neural
mechanism underlying neuropsychiatric
condition, combining CET with multiple
sessions of Transcranial Magnetic
Stimulation with concurrent TMS/task
performance and introducing Hebbian-like
learning, appears to be promising for
prolonging enhancement effects. (5)
5. Luber B, Lisanby and SH. NeuroImage. 2014 Jan 15;85(0 3):961–70

10. Neuroplasticity Enables Recovery
Changing of neurons, the organisation of
their networks and their function via new
experience
The brain's ability to reorganize itself by
forming new neural connections throughout
life.
Neuroplasticity allows the neurons in the
brain to compensate for injury and disease
and to adjust their activities in response to
new situations or to changes in their
environment.
Functional rehabilitation programmes
support neuroplasticity with goal-directed
experiential therapeutic programs in the
context of rehabilitation approaches to the
functional consequences of the injury.

11. Neural plasticity (Kleim & Jones, 2008)
1. Use it or lose it
2. Use it and improve it
3. Specificity
4. Repetition matters
5. Intensity matters
6. Time matters
7. Salience matters
8. Age matters
9. Transference
10. Interference

12. Aids to Enhance Memory
Low Tech:
 Checklists
 Diaries
 Orientation boards
 Wall calendar/ planner
 Hot spot
High Tech:
 Computer software
 Alarms
 Phones
 SenseCam
 Switches
 Dictaphone

13. Organisational Strategies To Enhance
Memory
Pay attention
Minimise distraction
Regular routine for everyday
activities
Provide a consistent and well
organised living environment
Break down tasks into
small, chunks
Encourage/Remind family
member to use strategies
Give plenty of time and
practice to learn new
things

14. Be Simple Be Seduced

15. Simple solutions………..

16. Seduced by Technology

17. Virtual Reality………..

18. Acceptable aids

19. The ‘Real World’ now.
Low tech High Tech

20. Cognitive strategies
Not a recipe or a ‘mental gym’

21. Strategies to Improve Attention
Minimise distractions
Talk yourself through the task “What
should I be doing now?”
Discover the best time of day to
work
Plan a schedule of activities
Set deadlines
Do one thing at a time
Structure the task within a set
time frame
Take frequent breaks
Use incentives
Don't rush things
Check work for errors

22. Results and Documentation
Monitor Regularly

23. Results and Documentation

24. In Nutshell
The advances in technology could mean more for society than just
new educational technology and virtual reality video games.
People with disabilities are finding innovative ways to put artificial
intelligence to work with their current conditions.
As the science improves, assistive technology will continue producing
new and improved platforms to help create a better standard of living
for those individuals.
But, its Healthcare Professionals who need to adapt and train the
people in an intelligent use of same.