Smartphone technology for fostering goal-directed ambulation and object use in people with moderate Alzheimer's disease.

Purpose: This study was aimed at assessing a smartphone-based intervention to help 11 individuals with moderate Alzheimer's disease and ambulation problems to manage goal-directed, walker-assisted ambulation and object use (i.e., to reach specific destinations and put away objects at those destinations independently).Method: The study was carried out according to a non-concurrent multiple baseline design across participants. Two measures were recorded, that is, the number of target responses performed correctly (with each target response consisting of reaching a destination and putting away an object), and the number of observation intervals with indices of enjoyment/appreciation (e.g., smiles and positive comments). During baseline, the participants were provided with a walker and three objects that were to be transported to and put away at specific destinations. During the intervention, the participants also had the smartphone-based technology that provided them with instructions about the destinations and objects, praise, and preferred stimulation.Results: During baseline, the mean frequency of correct target responses was virtually zero. The mean frequency of intervals with indices of enjoyment/appreciation ranged from zero to close to one. During the intervention, the mean frequencies for the two measures were slightly below three and just over three, respectively. The maximum frequencies possible were three and four, respectively.Conclusions: A smartphone-based intervention may be suitable to foster goal-directed, walker-assisted ambulation and object use as well as enjoyment/appreciation in participants like those involved in this study.IMPLICATIONS FOR REHABILITATIONA smartphone-based intervention may be used to promote goal-directed, walker-assisted ambulation and object use as well as indices of enjoyment/appreciation in persons with moderate Alzheimer disease.The technology for such intervention might involve (a) a smartphone with Android operating system, light sensor, Bluetooth v4.0, and MacroDroid, (b) Bluetooth headphones or earpieces, and (c) battery-powered light sources.The technology may provide the participants with instructions about the destinations to reach and the objects to put away at those destinations, and with praise and brief periods of preferred stimulation at the target destinations.The technology may be considered easy to access, friendly for the participants, and suitable for use by staff within daily contexts.

Promoting supported ambulation in persons with advanced Alzheimer's disease: a pilot study.

PURPOSE: This study assessed the effects of an intervention program, which combined the use of a walker with assistive technology, on the ambulation and indices of positive involvement of persons with advanced Alzheimer's disease. A social validation assessment of the program was also carried out. METHOD: The study included 10 participants with moderate to severe Alzheimer's disease and inability to walk independently. During baseline, the participants sat in their chair or were provided with a walker. During the intervention, the participants were provided with the walker and assistive technology, which delivered (a) preferred stimulation contingent on step responses and (b) encouragements to ambulate if needed. RESULTS: The participants' mean step frequencies were between 17 and 45 per session during the baseline and between 83 and 127 per session during the intervention. Sessions lasted 3 min. Most participants also had an increase in indices of positive involvement during the intervention sessions, thus showing an interest in those sessions. The social validation assessment showed that staff personnel rated the program favorably. CONCLUSIONS: A program combining the use of a walker with assistive technology may be a practical resource for improving ambulation and positive involvement of persons with advanced Alzheimer's disease. Implications for rehabilitation A program based on relatively simple technology combined to a walker device may support ambulation in participants with advanced Alzheimer's disease who are no longer able to walk independently. The same program may also help increase the indices of positive involvement (i.e., improve the general attention/activity and mood) of most participants. The staff's positive ratings of the program suggest that there may be a favorable attitude toward the acceptance and application of the program in daily contexts.

Patients with moderate Alzheimer's disease engage in verbal reminiscence with the support of a computer-aided program: a pilot study.

This study focused on the assessment of a program recently developed for helping patients with moderate Alzheimer's disease engage in computer-mediated verbal reminiscence (Lancioni et al., 2014a). Sixteen participants were involved in the study. Six of them used the original program version with the computer showing a virtual partner posing questions and providing attention and guidance. The other 10 used a slightly modified program version with the computer presenting photos and videos and providing encouragements to talk as well as attention and guidance. Participants were exposed to brief program sessions individually. The results showed that 15 participants (five of those using the first version and all of those using the second version) had a clear and lasting increase in verbal engagement/reminiscence during the intervention sessions with the program. Those 15 participants had mean percentages of intervals with verbal engagement/reminiscence below 10 during baseline and between about 45 and 75 during the intervention. The results' implications and the need for new research were discussed.

Persons with Alzheimer's disease engage in leisure and mild physical activity with the support of technology-aided programs.

Three studies were conducted to assess technology-aided programs to promote leisure engagement and mild physical activity in persons with Alzheimer's disease. Specifically, Study I assessed a program aimed at enabling three patients with mild or moderate Alzheimer's disease to choose among different music options and activate the preferred ones. Studies II and III were directed at patients in the low moderate or severe stages of the Alzheimer's disease who were no longer capable of ambulating and spent their time generally inactive, sitting in their wheelchairs. In particular, Study II used a program to help three patients exercise an arm-raising movement. Study III used a program to help three patients exercise a leg-foot movement. Each study was carried out according to a nonconcurrent multiple baseline design across patients. Results were very encouraging. The patients of Study I learned to choose and activate their preferred music pieces. The patients of Studies II and III enhanced their performance of the target movements and increased their indices of positive participation (e.g., smiles and verbalizations) during the sessions. The applicability of the programs in daily contexts and their implications for the patients involved are discussed.

Persons with moderate Alzheimer's disease use simple technology aids to manage daily activities and leisure occupation.

Two studies assessed technology-aided programs to support performance of daily activities and selection/activation of music items with patients with moderate Alzheimer's disease. In Study I, four patients were presented with activity-related pictorial instructions via a computer fitted with inexpensive, commercial software. In Study II, four patients were (a) presented with different music options and (b) allowed to select and activate the preferred option via a microswitch response. Study I showed that each patient learned to perform the two activities available with percentages of correct responses exceeding 85 by the end of the intervention. Study II showed that all patients learned to choose and activate music options. Psychology students, employed in a social validation check, scored the patients' behavior within the program better than their behavior in a control situation. The relevance and usability of simplified pictorial-instruction programs and music choice programs for patients with moderate Alzheimer's disease were discussed.

Persons with Alzheimer's disease perform daily activities using verbal-instruction technology: a maintenance assessment.

OBJECTIVE: To assess whether verbal-instruction technology could help persons with mild and moderate Alzheimer's disease maintain their recaptured performance of daily activities. METHODS: This study followed nine patients who had participated in previous studies aimed at helping them recapture one or more functional daily activities (i.e. table setting, coffee, tea or snack preparation, use of make-up and shaving). The plan was to follow each patient for at least 6 months after the intervention, unless his/her condition called for an earlier end of the study. RESULTS: The study was interrupted after 5 months for two patients who developed serious behavioural problems and continued for 6-14 months for the other seven patients who had largely accurate performance with some adaptations of instructions/steps. Most patients also showed mood improvement during activity. CONCLUSION: Verbal-instruction technology might be considered a critical tool to help persons with Alzheimer's disease enhance their activity and mood.

Persons with mild and moderate Alzheimer's disease use verbal-instruction technology to manage daily activities: effects on performance and mood.

OBJECTIVE: To extend the evaluation of verbal-instruction technology for helping persons with mild and moderate Alzheimer's disease recapture daily activities and improve their mood. METHODS: Two studies targeted two activities (i.e. snack preparation/sharing and shaving) with six and three new participants, respectively. Intervention effects on activity performance were assessed through non-concurrent multiple baseline designs across participants. The impact of intervention (activity) on mood was assessed by recording indices of happiness or indices of unhappiness during activity and non-activity trials. RESULTS: The use of a technology providing verbal instructions helped all participants perform the target activities. Performance was largely accurate with seven of the participants. Eight of the participants also showed mood improvement (i.e. increases in indices of happiness or decreases in indices of happiness) during activity. CONCLUSION: These results suggest that the approach reported may be a useful strategy for helping persons with Alzheimer's disease enhance their activity and mood.