As survivors of severe brain injuries, even highly educated and successful people have to relearn simple tasks that help them get on with their lives.
The Institute for Cognitive Prosthetics, in Bala Cynwyd, Pa., uses custom computer programs to help head injury patients overcome very specific problems, such as prioritizing items on a list, remembering when to do certain things, and concentrating on the task at hand.
When Institute Director Elliott Cole saw patients struggling to organize their schedules using notebooks at a brain-injury center a decade ago, he saw the potential for computers and custom software to go way beyond the notebooks.
Like prosthetic arms and legs, these programs must be custom-fit. Because the cognitive process is so complicated, however, each patient needs to be present when a program is being built.
“Our computing environment is designed around the premise that 5 percent of our work is initial design and 95 percent is modification and enhancement of applications — our patients’ requirements are constantly changing,” said Cole, who built the first custom application in the early 1990s and has worked with 18 patients since.
“Because we work on one-of-a-kind systems, our computing environment must give us the ability to quickly modify our code,” he said. The institute uses the Clipper database application-development language, from Computer Associates International Inc., and 486-based PCs to rapidly build and modify applications.
Clipper has several advantages for the institute. “Our primary need is for a versatile programming language,” said Cole. Clipper generates about one-third the lines of C code, he said, making the source code easier to read and debug.
The institute works with patients who have stopped improving using traditional therapy, Cole said. When a new patient like recent injury victim Susana Aguilera comes in, Cole analyzes the activities that person wants to perform. “We study the way the individual performs the task, noting those subtasks that the individual can perform easily and those the individual can’t perform. When we find something the individual can’t do, we build a technology bridge over it,” he said.
The institute builds custom spreadsheets, word processors, schedulers, and other personal-productivity tools for patients who use desktop or notebook PCs. The newfound ability to use these tools often opens up a development bottleneck, enabling further productivity.
“For someone with a brain injury, the person is much less flexible, so the technology has to be able to adapt to the user,” Cole said. Many patients with cognitive problems need more structure, making software that presents multiple options difficult to deal with.
Clipper’s prototyping ability is essential for a growing number of applications — including those that enable people with physical and cognitive disabilities to use computers, said Ken Orr, president of Ken Orr Institute, in Topeka, Kan. “Fast programming allows developers to work around what people can’t do — you can’t model behavior, you have to see it. Clipper’s a super tool for that,” Orr said.
The institute’s development technique helped a woman who survived a devastating automobile accident assist in designing an application that helps her prioritize tasks.
Before the accident, the patient, who has a graduate education, could usually tell in what order to perform a list of tasks to complete them in a brief period of time.
“After her accident, if you gave her a short list, she couldn’t prioritize it,” Cole said. Yet she could prioritize tasks one at a time. The custom software allowed her to assign a priority to an item, then repaint the screen.
The patient herself came up with this solution, Cole said. “We sat down to design, and after 15 minutes she said, in essence, `Move out of the way, I have a set of ideas.’ And over the next half hour or so we banged out something that really would work for her.”