Living Independently with a Cognitive Disability: How Technology Can Help

This webinar, led by AbleLink founder and president, Daniel K. Davies, offers parents and professionals great insights into person-centered technology that supports development of skills needed for independent living. A link to the accompanying PowerPoint is included.





- [Voiceover] Good evening, everyone. This is John Newman from the Center on Technology and Disabilities, thank you so much for logging in and attending another one of our webinars here today. It is my great pleasure to introduce today's speaker, Dan Davies. Here at the Center on Technology and Disability, we've been very excited to cover the topic of independent living, and we really couldn't think of anyone better to invite to speak here today. Dan is the president (audio cuts out) Technology, which is an assistive technology company that has really been kind of on the forefront of developing technologies lead more independent lives. We're so excited to have him here today. I'll turn it over to Dan and he can now get us started.

- [Voiceover] Okay, great. Thanks for attending the presentation this afternoon. The focus is on independent living, specifically, for individuals with cognitive disabilities. To give you a little bit of background, I worked as a counselor and a case manager in the intellectual disability and development disability adult services field, as well as had a variety of other experiences, notably, worked as a human practice engineer for the FAA's air traffic controller workstations, et cetera. I have human factors engineering expertise, and this experience that I had really has played a lot into looking at the problem of how to develop technologies that are accessible to people with cognitive disabilities.

The research that we begun started back in '91 on this. I started AbleLink Technologies back in 1997 to focus specifically on the area of cognitive disability. AbleLink Technologies is in Colorado Springs, Colorado, and our mission is to, as it says on the screen there, is to do research, development and delivery of technologies, and really focusing on delivering them. While the research is important, and a key component of developing these technologies, we really focus on trying to come up with practical solutions that can be put in the hands of folks to help them live more independently.

What really got me into this field personally is my brother John, in the dark blue shirt there. He's my oldest brother and was born with severe intellectual and developmental disabilities. That's me, pictured there far to the right. So, this picture is a bit old. When we started work in this area, technology was much more of a novelty, and certainly not the necessity that it is in participating in today's society. But I'm sure everyone would agree that nowadays, it is no longer a novelty. It is truly a necessity for participating fully in all aspects of life. To put things in perspective a bit, related to cognitive technology and then some of the other technology populations, there's been assistive technology for many years.

Here's, an example is the augmentative communication device industry. I pulled this picture off of Prentke Romich's website recently. They're celebrating 50 years in this area. Because of that, there's been a lot of opportunity over the years for the efficacy studies to be conducted and their outcomes to be documented of these types of communication technologies, which has led very much directly to funding legislation that has allowed communication devices to be funded much more readily than some other types of assistive technology. In comparison, the cognitive technology field is really just getting started. It's maybe a decade and 1/2 old now. But the long-term studies, longitudinal studies, haven't really been done. There've been lots of shorter-term studies that have showed the benefits of cognitive technologies. But, you know, limited scope on those. Therefore, the funding really hasn't been impacted. But there is an increased focus from universities, government, and beginning, also in the private sector, from companies, in this area of cognitive technology.

Now, while that was all going on, a few years ago, really the whole technology industry's undergone a revolution with the half revolution in mobile devices and the proliferation of app stores and 1,000s and 1,000s of, in many cases, single-purpose apps that have been developed, some which are tremendous, some which are not. Finding them can be a great challenge, and understanding what are the good ones, what are the bad ones, what to stay away from, where to spend your money, all that. There are lots of resources. Just, for example, in the area of autism, lots of websites that talk about the different apps and specific devices that are useful for folks with autism. My focus today really isn't on, you know, listing up a bunch of apps for you. There's lots of resources out there for that type of thing.

Couple of the best resources on assistive technology is AbleData, which is funded by the government, as the largest database of assistive technology devices. Another great resource is the QIAT ListServ, Quality Indicators for Assistive Technology, which brings together professionals in the field. Many of you listening today may be members of the QIAT organization and participate in that ListServ. Great place for information on best practices and feedback on specific apps and that type of thing. Today, I wanna focus on the kind of technologies that have more of a research, longer-term background with evidence that has been published in journals and things like that. Some of the organizations involved in these are pictured up on the screen right now. As I go through here, I'll talk about some of the examples of the cognitive technologies that are being used for independent living for these folks and are from these organizations.

There are a number of things that have been happening over the last decade that has really accelerated the field of cognitive technology. Hopefully, and I don't believe we're gonna have to wait 40, 50 years for funding legislation to be impacted and great cognitive technologies to be available like there are in some of the other fields. Some of the reasons for this is, there's a growing recognition that there's a need to provide research and technologies to help individuals with hidden disabilities, cognitive disabilities, for example. You know, we're not any longer just accommodating things that we see. There's a lot more work now going into cognitive disability and things that are difficult to see and, in some cases, difficult to identify the proper ways to go about creating accommodations for these folks. The cognitive populations have also been growing. Veterans with traumatic brain injury from the last decade or so, from different conflicts overseas, has brought increased research funding and increased attention to the need for cognitive technologies, as well as the increasing, or the prevalence of, autism spectrum disorders.

Right now, one in 68 children have autism. Almost five times as many of those are boys as opposed to girls. So there's a lot going on there, and a lot of research going into the area of autism. In addition, the whole area of seniors and the aging of not just America but the world is driving work into identifying technologies for independence and aging in place. There's a lot of parallel between technologies for senior that are experiencing cognitive decline and veterans with traumatic brain injury, as well as individuals with other types of cognitive disabilities because, when you're looking at functional needs to live independently, those needs are often very common. And the solutions, then, that can be helpful for a senior to live independently may also be helpful for some of these other folks, as well, and vice versa.

Just about a year and 1/2 ago, the Coleman Institute for Cognitive Disabilities, one of the leading research and advocacy organizations related to individuals with cognitive disabilities and cognitive technology, they have a conference every fall in Colorado, and at their 13th annual conference last year, they introduced a declaration of the rights of people with cognitive disabilities for technology and information accesses. This is a YouTube video here I'm not gonna show, but that they have available on their website, that explains this declaration and provides an opportunity for both individuals and organizations to sign up and endorse the declaration.

I encourage you, that AbleLink Technologies has done that, as well as lots of other organizations. Specifically, the work we've been involved in in the area of cognitive technology development began, as I mentioned earlier, back in the 90s. Much of our funding's been from the Small Business Innovation Research Grant funding from a variety of different agencies, NIH, Department of Education, ACL, et cetera. We've collaborated on those projects as well as other projects with universities and other disability organizations, some of which are pictured here, the University of Kansas, Colorado, organizations like the Council on Quality and Leadership, I'll be talking a little bit about their Host app that they have.

And the outcomes from this has been both journal articles and that type of thing, but in addition, commercially available cognitive support technologies. Some of those I'll show you today, but I'll be also showing some of the other things that are out there. What's technology all about? The basic definition of technology is right here, "the application of scientific advances "to benefit humanity." Kind of a key word here that I focus in on often is benefit. That's the intent of technology. However, too often, we have this type of experience with technology.

Technology can be extremely frustrating, whether it be our smartphones or tablets or desktop computers, whatever they might be, they can be extremely hard to figure out what's going on, things are changing all the time. There's actually a technical term for this. It's called the technology paradox. As technology becomes much for functional, the usability of it actually decreases, goes in the wrong directions. As you look at this chart, as functionality increases here, let me get my pointer on the screen, so as technology starts with low functionality but increases in this way, the usability actually goes in this direction, which is from high over there to low. Donald Norman, in a book nearly 30 years ago, coined this term, the technology paradox. You'd think in 30 years, we'd have solved this problem. But no, it just seems to get worse all the time.

Initially, technology is focused on a core functionality. The first cell phones, the first calculators, the, you know, whatever. Here's another example, get up on the next page here. Early microwave ovens. When they came out, they had a couple of knobs, one for how long do you wanna cook it, and the next for how hot do you wanna it to be. But as we've improved and added functionality, we've now got microwave ovens that do all kinds of things. But figuring out how to do those things is often very challenging. Same can be true with other everyday technologies that we use.

How many of you remember this picture, from the movie Wall Street, with Gordon Gecko walking along the beach with his cell phone? That cell phone basically did one thing. It allowed him to talk to somebody else. He couldn't check the sports scores, he couldn't, you know, check his stock quotes, any of that. About the only use for a phone these days like that is self defense, maybe. Now we've got phones that look like this, and they do millions of things. But they only do those if the interfaces are designed in such a way to allow you to do the things that you need to do. They can be extremely complex.

For people with cognitive disabilities, this problem is even worse. Mainstream developers assume many things. They assume that we, you know, everybody can use the keyboard, everybody has no trouble remembering passwords and using the keyboard to type them in or even tap them in on a mobile device. When there's text on the screen, mainstream developers often will assume you can understand and comprehend what's on that screen. But just because you can see it doesn't mean you can necessarily comprehend that. And there's, of course, all the different ways you navigate around technology, scroll bars and drop-down menus, et cetera. All of these create barriers for individuals with cognitive disabilities.

There's many hardware platforms that are coming out all the time. It's incredible how many different tablets there are. If you go to Best Buy or a store and try to pick one out these days, or a cell phone, the challenge with any of these devices, then, is of course, operating them. And the key there is gonna be the user interface, the software, what software are you running on that device to be able to do some sort of function? The solution that we've focused on and the research that we've done and the organizations that are in this field of cognitive technology focus on cognitively accessible technologies. These are needs-based and very person-centered designs that have a lot of ability to customize the user interface.

The user interface is what individuals see on the screen and what buttons are available and things like that. Categorize these into two different types, everyday technologies that are cognitively accessible, and then specialized technologies that augment cognitive ability. The first type, cognitively accessible everyday technologies, these are basically the same types of technologies that everyone interfaces with, but with software that can make them easy to use and cognitively accessible. They may be a Skype-like application or FaceTime-like application, or a GPS system that's designed for folks with cognitive disabilities to navigate the bus system, et cetera.

The purpose of these is to focus in on that core functionality of what that technology is about, whether it be communication or travel, et cetera, but providing a accessible interface that can, along with a hardware device, allow an individual with cognitive disabilities to do the same things that everybody else is doing with that particular technology or device, so cell phones or schedulers or email programs. The focus may still be on a particular core functionality, this area here, but the usability is higher. And the usability is higher partly because the functionality isn't designed to do as many things as another device might do, or that additional functionality can be turned off or kind of hidden from the screen, and therefore the application be simpler for the end user.

That is the focus of accessible everyday technologies, high usability to allow you to do some core functionality with the technology. Here's a specific example. Mainstream scheduling technologies often, here's a smartphone showing a reminder event. You know, it might beep at you and then present this on the screen. But reading is quite often assumed by our mainstream development organizations, and therefore can be completely inaccessible for folks with cognitive disabilities. Alternatively, using video and audio to present reminders to individuals, with interfaces that can be very customizable. You can turn components on or off, et cetera, based upon the needs of the end user. And when the time comes for a event to fire, that's all you see on the screen. Everything else is gone. It's not just one thing amidst a number of other things. It can take over the entire screen, present audio, pictures, and text, you know, for folks who can benefit from that, to really provide a simple way to get a event, in this case, or a reminder.

These technologies also can be very extensible, in that they may interface with other technologies that are on the same device. For example, this "Take your morning blood pressure," this reminder fires off and says it's time to do that. But immediately, as soon as the end user responds to this, they could be presented with step-by-step instructions, with pictures and video if need be, as to how to take your morning blood pressure. So extending the technologies and having more than one application work together, as well as the ability to potentially have a remote caregiver receive a message that says, "Person completed this task at that time," are all the ways in which cognitive technologies can be used in a broader environment.

These are not just silo, single purpose apps that do one thing and may do it well, or maybe not do it so well. They're really designed as a system that can facilitate independent living for folks with cognitive need. Another example of everyday technology that our friends at Microsoft and Apple would think their interfaces for iTunes and Windows Media Player are very simple and intuitive, et cetera. However, just simply double-clicking or moving a scroll bar can be just challenging and make a technology like this not usable for folks with cognitive disabilities. An alternative that allows a picture-based, with audio, simplified interface can really make the difference for folks with cognitive disabilities.

Throughout this presentation, there's a few places where I'll point out a YouTube video, I'm not gonna show the video, but a YouTube video that illustrates a point with the technology that I was just showing. There's a video in our YouTube channel here, called the Visual Media Player testing, that allows you to see this type of technology in action. As you can see from these examples, people with cognitive disabilities are using lots of different technologies to live more independently. These are scheduling, task prompting, a couple those examples.

Back in, it's almost 10 years now, it was 2007, nine years ago, we put together a video for the Coleman conference, called Living the Smart Life. And this video presented a day-in-the-life story of Rusty, an individual with Down's syndrome that, you know, was coming back from walking his dog at the park and he got a email message on his audio picture-based email that said his girlfriend was coming over for dinner. So he has to go to the store and prepare, you know, the dinner, et cetera. So this story is on YouTube, also, it's called Living the Smart Life.

For individuals that have not really been exposed to this area of cognitive technology, it's a great way to introduce the topic and show how technology can be incorporated into an individual's life. But the point isn't technology, the point is enabling individuals to do the things that they want to do and live the life that they wanna life. And technology can play a role in that, but obviously, it doesn't help with everywhere, and people don't need technology everywhere. It's just, when you add that to the tool box of things an individual might need to get through their day. So Living the Smart Life, I just wanted to point that out to you. That's also a YouTube video that's out there.

Let's talk a little bit about this second area of cognitive technologies. These are specialized technologies that, basically, everybody's on the continuum of cognitive ability somewhere. These types of technologies basically are, when added to the individual's own abilities, together they allow them to perform a task better, or maybe a task that they couldn't have done without the technology. These aren't necessarily considered everyday technologies. They're more specialized, specifically because of the needs of folks with cognitive disabilities. An example here, from one of the organizations developing cognitive technologies, is Picture Planner. Picture Planner is from Cognitopia, out in Oregon. They've been working on this and doing research for a number of years. This tool is an activity scheduling tool, for folks with cognitive disabilities. It can help with not only knowing that it's time to do something, but the dimensions that go along with performing a task, so, in this case, what is the task? It's jogging. Who is he gonna do it with? Friends. Where? It's gonna be at the park. How's he gonna get there, et cetera. What clothes does he need? This is an example of a technology that, you know, meets this category of a specialized technology that is designed specifically to help folks with cognitive disabilities.

Another area, there's been a lot of work in this area, visual prompting technologies or just prompting technologies in general. Visual now because there are lots of visual devices you can use. We began work in this area in the early 90s. Basically, with these types of technologies, you can present pictures and audio and video together in a step-by-step manner in a very personalized way. The pictures that you see here were a desktop computer. This is before PDAs and smartphones and tablets existed. This next screen that shows some of the audio prompting technologies from those early days, too. Our first system was called Pocket Coach. You see it listed here.

Here's our prototype, in 1993. We manufactured this on a piece of sheet metal and put stickers on it and LEDs here, and you could have up to eight steps of a task, and these LEDs would turn out, they'd go out as soon as you completed a task. And you hit the play button, it would play an audio message for the first instruction in the task, et cetera. Cassette tape players, which was the other technology that you could use at the time, really didn't lend themselves well to a step-by-step presentation, because those of you who have used those would understand why. Oh, as the years have gone on, these types of technologies, prompting technologies, have taken on many different forms. In '95, this was our first hardware unit that we actually sold. It was a dedicated hardware unit, called Pocket Coach, that had audio recording in it, you know, way before there were PDAs and smartphones, et cetera.

So then, as they came out, these types of prompting technologies were possible with these new devices. And nowadays, you got all kinds of ways to do video modeling or task prompting, whatever term you wanna use. These are some pictures here from some iPads, or Android tablets, or smartphones. Ones of the keys here is, you know, building content to present for individuals to help them perform a task takes some time and effort to think through, what are the steps that you want to provide, what pictures do you want, what audio, et cetera. So there's some effort and thought that goes into that, basically a task analysis that you're doing. And once you've expended that effort, it'd be nice to be able to reuse that on multiple platforms.

So now, with these visual prompting technologies, that's possible. The same task, for example, that you see here, take your blood pressure, is being presented on the tablet, over here, it's on a Android smartphone. So whether it's an Android phone, a Apple device, or even Windows, the same content of a task can be shared acrosst all of those platforms, which really helps with extensibility and making the most out of the time that you put into creating content, with devices like this. As a very specific example, here's a iPad application for video modeling called Visual Impact.

The content that's displayed on the screen presents different tasks, taking care of pets, cleaning the house, whatever it might be, visiting the doctor, and there's a cloud button up here, which, when you click on the cloud button, it allows you to go up to the cloud, to select more content, more tasks, to download to this device. And that task might have been created on a different device and uploaded and then, you know, downloaded for use for this specific individual. In this case, if I'm selecting a meal, maybe the grilled cheese sandwich, I can select that, hit the download button, and then that shows up right on my device. That has pictures, audio and video to walk a person through this task. This happens to be a task created, or some content created by Attainment organization. We've got step-by-step instructions.

This type of technology can be used in all kinds of different ways. As I said, you create it in one location, upload it to the cloud, and then download it for use on pretty much any device. Another way this kind of technology can be used is to group it together in a set of learning content that lots of different folks can use the same set of tasks. In one case you might have a very specific task for an individual, like the one I showed you before about taking blood pressure. But in other cases, just providing a way for individuals to self-direct through a learning activity can be done and the same content could be shared across lots of different individuals.

So what you see on the screen here is some safety-related content in an app. Again, that is Attainment and AbleLink partnered together for folks with cognitive disabilities. I'm gonna talk a bit now about how organizations are using these types of technologies, as well. Individuals, as I've shown you up to here, certainly using cognitive technologies. But in lots of cases, individuals with cognitive disabilities are also being served by agencies and organizations. Not in every case, obviously, but in many cases that's true, for folks with intellectual and developmental disabilities, for example. And these pictured on the screen are some of the organizations, just a sampling of those that are using cognitive technologies as part of their programs and services within their organization.

One of those is Westchester Institute for Human Development, using iPad-based curriculum for health planning for individuals. So you see this application called My Health, My Choice, My Responsibility. There's a variety of sessions in here. And again, these are all designed for use by the individual themselves, to learn about a particular topic, in this case, personal healthcare. As they select a session for Get Moving, there's a variety of things they can do. They can listen and watch a little video to teach them about that. They can take a little quiz that tests to see if they've learned what the video was teaching them. These pictures on the bottom are basically little reminders of the most important content, again, all presented in a very simplified interface that individuals can self-direct through that task or activity.

Increasingly, agencies are using these types of technologies in both at the agency as well as out in the community, you know, in their supported employment activities. Trinity Services, here, outside of Chicago is using some of this video modeling technology on portable devices. This is a screenshot from a video that they have out that shows the use of a tablet with the step-by-step instructions on a movable cart that this individual, in his workplace, he moves around and those tasks help him remember what to do, with pictures and with audio.

Another organization in Connecticut, it's an organization from Ability Beyond called Roses for Autism, in which they have a variety of greenhouses that put together roses that are packaged for the different businesses around the state. They use this type of technology on a tablet computer to allow individuals at a particular workstation to learn how to package the roses, or weave the roses, whatever it might be. This happens to be a Windows tablet that's being used in this case. These are good examples of tasks where the same task is used by multiple individuals at that workstation, at different times of the day or different times of the week.

These technologies really can, for agencies that are serving individuals with cognitive disabilities, address a broad spectrum. They can be focused on helping the individual have their voice heard, access to community, knowing when and how to do things. We've seen a little bit of that with the prompting and the scheduling technologies. Or using other everyday technologies, maybe communication with family and friends, with an audio email program, or accessing the Web with a simpler web browser, et cetera. So, for example, in the area of testing and surveying. One of the challenges, as I mentioned earlier, for folks with cognitive disabilities, many folks with cognitive disabilities, not all, is reading. So providing feedback or testing, completing a test, that typically is presented in written format or even online.

I see at the end of this session today, you have the Center on Technology and Disability has a SurveyMonkey link for you to click on to provide feedback, et cetera. Well that, for folks without cognitive disabilities, those can be great. At agencies that serve people with cognitive disabilities, oftentimes, it's a paper tool that they're working off of to try to gather feedback from the end user, and that's very difficult when the folks can't read on their own. So a process that's done is an interview quite often, where a staff individual will ask the person, "Well, how happy are you with the services "that we're providing you?" Well, research has shown that there's biases introduced, definitely, in that type of presentation.

So, to the extent that you can help an individual have the opportunity to independently provide their feedback as much as possible, is much preferred. This system, ATLAS, stands for Accessible Testing, Learning and Assessment System, came out of some research funded by the US Department of Education on developing cognitively accessible tests and surveys. What's shown here is a iPad screen where the items in a survey are presented one at a time, with the responses. You can see the text on the screen, but what you don't hear, obviously, is when this page comes up, the item is read to you. When you select a response, each of those items are read to you in a human voice, not a computer-generated voice, to simplify helping an individual take a survey by themselves. As they take this type of survey, the data is shipped to the cloud. If it's an agency serving folks with intellectual disabilities, they can immediately take a look at the feedback from the individuals that are completing the survey.

This is a sample screenshot of some of the data you can get to online for an organization. One example is this system called ATLAS VantagePoint. This is a set of self-directed satisfaction surveys for an agency to just kind of use right out of a box, not customization necessary, that helps individuals with cognitive disabilities provide feedback, which can be critical to an organization for understanding how well are they doing in the residential services area, in the supported employment area, or whatever it might be. This particular tool provides completion certificates for the individual when they complete a survey, just to have that sense of accomplishment as they're going through something like this.

This type of technology is being used by lots of different organizations. Some are pictured here. CSRI is a service agency in Ohio, Charles Lee Center is in South Carolina, Hammer is in Minnesota, all adult service agencies for folks with intellectual and developmental disabilities, and they're using this type of technology with their own surveys to gather information from the individuals that they serve. The CQL Post app, CQL is the Counsel on Quality and Leadership, and they have an app that corresponds with some of the other tools and services that they provide, which is a personal outcome screening tool, designed for folks with intellectual and developmental disabilities to be able to provide that feedback directly to the organization. In this case, the feedback is related to how well different things are going in their life.

In this case, for example, how is it going for you right now when it comes to making decisions that affect your life? Individual can go through this and provide their responses, but not only say how well it's going, but also provide feedback on how important that is to them. That information, then, is very useful for being able to identify areas of priority for the individual. Again, for an agency that is trying to provide the best services possible and help an individual achieve maximal quality of life, it's important to know, well, what's important to the person, and then, how well are they attaining goals in that area?

So that's another example of this technology of accessible testing. Another area, completely different, is transportation, navigation around the community. There are lots of GPS technologies out that can help people get from one place to another, but very few that are designed specifically for people with cognitive disabilities. One example here is the system called WayFinder, which is used on a smartphone with pictures, audio instructions, and driven specifically by the GPS location of the individual. So as a person gets to the bus stop, it can tell them, "It's time to get on the bus. "Look for this bus," et cetera, when to ring the bell, all that kind of thing. So it's very personalized GPS system for folks with intellectual disabilities.

ARCA is an organization in Albuquerque, the Ark of Albuquerque, tells of Laura and William, a couple of individuals in their SmartTravel program that have used this type of technology to get away from paratransit and to get out of home and out of being dependent upon others for getting from one place to another. Laura had an accident that left her too scared to take the bus independently. But with their SmartTravel program and using this kind of technology, she reacclimated to traveling independently, and now, three times a week, is taking the bus by herself, supported by the accessible GPS technology.

William, similarly, he was going to a Day Hab program, didn't wanna rely on staff or waiting for paratransit, to be able to get there. He would take, he learned how to use the bus system using this cognitively accessible technology. I love their story where he says he loves it so much he even shows up on his days off of work. That's how much he likes riding the bus with the technology. ARCA has a website, they talk about their program, again, the SmartTravel program. It's been very successful. So this is a place you could go visit if you'd like to learn more about that. Also, there's a YouTube video on our YouTube channel that shows this system in development during the research project. Chad here is about ready to get on the bus for the first time by himself, so kinda follows him along that path. So check that out if you're interested.

Few other areas that cognitive technologies are being used for individuals. On desktop computers, like a Windows computer or a MacIntosh, the barrier to doing things often is a result of the operating system, the challenge of the operating system. Double-clicking an icon, understanding what things are gonna do when you click on it, can be real barriers. A cognitively accessible operating environment can be basically run on that same computer to present a very simplified way to access just the things that you care about. Here's a screen from the system called Endeavor Desktop that has a button for classes, activities, and free time, and it's kind of student-oriented in this case.

As you click on those, it takes you to functionality and things that are presented in a very cognitively accessible way. The content on the screens is very personally driven. If the individual is a big Elvis fan, here, Jonathan happens to be, he's got Elvis on the backdrop of his computer screen, and then some tasks for an audio email program, simplified email program, or step-by-step instructions for cooking dinner, whatever it might be. Another individual may have a completely different set of content. But again, it's designed to be customizable for the needs of the individual. So if Jonathan wants to send an email out, he just touches the picture of the friend that he's sending the email to, and can speak his email. The computer records that and sends that email as an audio file that can just play for the recipient.

In other cases, if the individual has reading ability, they just may need a simplified interface for the email program. Email programs have so many different bells and whistles on them that they can be challenging for folks with cognitive disabilities. Having a simplified email program can really open the doors of communication for folks that haven't been able to do that before. With the path content we looked at earlier, the step-by-step instructions, again, they can be presented on the same device, with very customizable content, caring for the dog, taking care of the dog, for feeding him, et cetera, or filling a pill organizer. The path content is personalizable so that you set up the set of instructions for the individual, or the individual can create their own set of instructions with their own voice and take the pictures that they want, if they need help remembering how to do tasks in a step-by-step manner.

You know, not to be forgotten, one of the great uses of technology is entertainment. Having a simplified media player that allows you to launch into programs or watch movies and listen to music is of interest for folks with cognitive disabilities. You know, it's just as important as knowing how to take care of the dog. Having the ability to launch whatever program that you want on the device, so if this gentleman here likes iTunes and can navigate the interface of iTunes, then maybe that's how he wants to watch his movies. You're not locked into any environment with these types of cognitive technologies.

You really gonna configure the individual's technology world in a way that meets their needs, and that's why it's person-centered. I already talked about the path prompting, that video modeling that can be presented on these types of computers, or the media player that is very simplified that can be presented very personalized, again, to the individual. Having a web browser that gives you the ability to turn off all the stuff that you don't need, all the buttons, even the address bar. If the individual using it can't really type in, with the keyboard, an address into the address bar, or can't really read that, there's no need to have that on the screen. It's just cognitive complexity.

I can't tell you how many times I've been to my dad's computer, and he's got so many things on his web browser that have been downloaded as tools onto the bar across the top, it's really hard to navigate anywhere. Email is another very powerful use of technology. Having a cognitively accessible email program opens the door for that, as I mentioned, for folks. So, picture-based with the ability to have audio, not having to use the keyboard at all, those are all powerful components of a cognitively accessible email program. Even showing, across the bottom of the screen, the attachments as little thumbnails instead of a paper clip, for example, can be a great way to show that, hey, there's pictures there. The paper clip may not really convey that message.

One of the projects that we currently have going on is this system called Digital StoryTeller that helps folks with cognitive disabilities tell a story by creating their own multimedia book, basically, selecting pictures, recording a message to go along that picture, and then having a video created at the end that basically is their own personal story about, you know, a trip to the zoo or whatever it might be, maybe a book report that they have to do for school. On our YouTube channel, we've got a short little video of Matt using Digital StoryTeller and telling you from his perspective about that process. That's another thing to check out if you're interested.

Lots of things that you can get to on the Web oftentimes are just not accessible to folks with cognitive disabilities. These screens here show an accessible picture viewer, a way to have the text from an RSS news feed read to you and not something where you have to read it through the browser. All of those are components of a cognitively accessible operating environment. Here's a couple of stories of specific individuals. Sarah uses a software, she's served by the agency called Hammer up in Minnesota. She uses it for all kinds of things, practicing her relaxation, et cetera. And they have told stories of how this technology's been very helpful to Sarah navigate some really challenging times of her life, because she had the ability to go and do her relaxations exercises when she wanted to. She was in control. It helped her navigate challenging times, in this case, when a close family member had passed away. Another story they shared was Andy. Andy had difficulty with communications. He didn't verbalize much. By using an email program where he could touch a picture of his mom or his friends, and then, initially through some prompting and support from the staff, he would start talking into the email program and then sending that to the recipient.

So they shared a story where, after some time learning how to do this by himself, Andy started sending emails to his mom, and he closed one out one day with, "I love you, Mom." She hadn't heard that in years and called the agency the next day, just in tears, she was so excited to be able to have that kind of communication from Andy. Another area, which is a growing interest, is social technologies and social connectedness. This is a Facebook page that I'm showing you right here. This screenshot was taken a couple of years ago. Facebook looks completely different frequently. So navigating Facebook with all the things that are going on, and the ads, et cetera, can be very challenging. So we've done some work in the area of creating accessible tools for accessing Facebook.

Again, this is exploratory research. This isn't anything that is out today, but certainly will be in the future. Simplified interfaces that just present on the screen the important things is really what this is all about. If you can't read what's on that screen, you tap a button and it reads it to you, that type of thing. There's a short video on our YouTube channel of one individual using a prototype system called Endeavor To Connect. In the last February issue of Intellectual and Development Disability, there's an article on the research that went into this system, if anyone's interested.

I'm gonna finish up, I've got about five minutes left. So I'm gonna go through fairly rapidly. There's lots of communication technologies out there. The key I wanted to point out here is, when you have a communication technology that could be integrated within these other types of everyday technologies, so here's a picture of a visual media player within this desktop environment I've been showing you, where the pictures in the middle here actually play a song when you tap them. But on the left and on the right, these buttons actually speak. These are communication buttons. The one on the left will say, "What song would you like to hear?" And the one on the right says, "Here's one of my favorites," so that the individual can speak a message to a friend and then play the song right away, so the engagement and enjoyment, they go hand in hand. Being able to bring communication right in the context of some life activity is important.

One of the growing areas, too, is the area of smart homes. Organizations are looking and utilizing more and more remote monitoring technologies to provide support to individuals from a distance, the same types of supports that they have been providing, in person, locally, but have tried to provide a way for individuals to feel more independence and live in a more independent fashion. Remote monitoring can allow agencies to, from a distance, provide that type of support. Syngistics, SimplyHome, Rest Assured are some of the companies that are doing this type of, using this type of technology.

With these systems, shown here is a thing called the Smart Living Console, an agency that is serving multiple individuals can pull together lots of information that may show what the next event for the person is, if there's some sensor technology that's in play. And then, as you drill down, what activities are yet to come, or if the person's missed any? Do they get a chance to get out into the community with GPS technology, whatever it might be? So there's lots of different ways that technologies can support individuals both living independently, without agency support, as well as living independently with agency support.

In conclusion, what types of things are needed moving forward? First off, I wanna bring up again the rights of individuals with cognitive disabilities to technology and information access, that declaration that the University of Colorado's Coleman Institute on Cognitive Disabilities put forth. It wasn't created just by them. They kinda led the charge, but lots of organizations around the country contributed to that statement. So, recognizing that in a broad way for organizations or development technologies is very important. Continued funding, and particularly, funding in the area of longitudinal testing of technologies that really provide us the documentation to be able to show the benefits of these technologies so that these technologies can be supported and paid for with funds that are providing support for other assistive technologies, like communication devices.

And finally, getting the word out and being able to see life examples of how cognitive technologies can change the lives for folks with cognitive disabilities is this area of education and awareness. And, you know, utilize your own platforms to be able to communicate that folks with cognitive disabilities can experience incredible enhanced quality of life through the right technologies. Experts that are involved in selecting them need to understand and know what's out there. That's part of the purpose for today, is to just communicate some of that to you. So with that, I thank you for your attention today, and look forward to this whole area of cognitive technology moving forward and your participation in it. Thank you very much.

- [Voiceover] All right, well, thank you so much, Dan, for that exciting presentation. It was really interesting to see all the different ways that the advances of technology are really helping individuals with cognitive disabilities just lead really great, integrated lives. Once again, thank you everyone for attending this webinar today. You'll notice we just put up a link to the survey. If anyone that's attending today would like a certificate of participation, they can just click that link to the survey and fill that out. And once they've filled out that survey and given their feedback on our event here today, there will be a certificate of attendance displayed, and you can print that off and use that however you'd like. So once again, just a big thanks to Dan. And Dan, before you go here, I think there is just one question that we didn't catch, which was, that smart living console that you were showing a moment ago, do you have a name for that one?

- [Voiceover] The Smart Living Console is actually the name. It's a software application, one of the ones that AbleLink has developed in cooperation with some other agencies that helps remote supports, particularly person-centered remote supports.

- [Voiceover] Great. And also, too, for others that didn't catch it, you'll notice in the lower left-hand corner there, you could also download the PowerPoint that was used today if you wanna reference anything else that Dan showed during this webinar. But we wanna thank everyone again for their attendance, and a big thanks to Dan for presenting this evening. So, thanks everyone, and we look forward to your feedback on the survey.