The Institute for Cognitive Prosthetics has been primarily an R&D organization, applying computer science concepts to problems in healthcare. Our original work was in traumatic brain injury rehabilitation of cognitive disabilities, primarily from accidents. This area was selected for both its social significance and aspects of research design. This work quickly led us to working in the patient’s home, where it became relatively easy to produce clinical advances in people who had plateaued in their recovery.
In the early 1990s, we created a model brain injury rehabilitation clinic, in part to help support our R&D efforts, and in part to demonstrate to the rehabilitation community the strength of our modality of therapy coupled with the support we received from insurance companies and private payers. Our culture has encouraged close collaboration between clinicians and computer scientists, supported by PhD research designers. Bell Labs helped us expand to other causes of cognitive disabilities. One of their scientists had suffered a stroke causing cognitive disabilities, and efforts by major rehab hospitals had failed. A Labs researcher saw a paper presentation at an international conference, and thought our method might help (it did).
As people learned of our work, we received requests from patients with other etiologies of cognitive disabilities. Our software development continued, and with that, additional functionality led to broader uses for both therapists and their patients.
As a visiting scholar to the University of Pennsylvania’s Organizational Dynamics program, and working with its executive director, Larry Starr PhD, I came to realize that we had developed and refined a Hospital-to-Home Telehealth modality of therapy. It provided therapy services along the broad outpatient continuum, from intensive “day hospital” care to occasional contact, so that crisis intervention could be provided when needed.
Hospital-to-Home telehealth enables the clinician to observe the patient in the natural settings, home, workplace, school. This provided added and different information that could be applied to therapy, better addressing problems that had been elusive. For the patient, receiving therapy in their own settings made it easy to apply therapy skills to their own lives and activities. And these became critical parts of our Patient-Centered Design model.
As a result, we have been very productive in product design and very productive in conferences and publications. Over the years, we have made over 100 publications and presentations in the US, Canada, the UK, Europe, and Australia. Our culture has also encouraged us to organize panels and sessions at professional meetings and consumer conferences, as well as grand rounds and in-service training.
We have several different slices of data: clinical notes, clinical testing, patient work-products (and the history of each), computer logs of patient use, videos of patients and therapists working, and comments by patients. Because of our environment – clinical, software development, and research – we have substantial opportunity to observe and talk to our users (patients, caregivers, clinicians), which gives us a richer sense of the raw data which we collect.
To learn more about Hospital-to-Home Telehealth Sessions™, please call us at 610-715-0400, orto email us.
Our recent work
“Collaboration Therapy: A process model of technology-enhanced patient-centered therapy for complex medical conditions”, Institute for Cognitive Prosthetics Working Paper Series (2015).
“Hospital-to-Home Telehealth – a structural model of technology-enhanced patient-centered therapy for complex medical conditions”, Institute for Cognitive Prosthetics Working Paper Series (2016).
Patient-Centered Design of Cognitive Assistive Technology for Traumatic Brain Injury Telerehabilitation, by Elliot Cole, PhD, 2013. The ebook is available for downloading at many major university libraries with subscriptions to Morgan & Claypool Publishers, for purchase at morganclaypool.com for the PDF and PDF Plus electronic versions and on Amazon.com for the print edition and content-preview. This book is part of the Morgan and Claypool computer science series on Assistive, Rehabilitative, & Health-Preserving Technologies.
Primary articles (pdf)
“Patient-Centered Design: Interface Personalization for Individuals with Brain Injury”, 2011
Because cognitive assistive technology can help achieve a partial recovery in patients with enduring cognitive disabilities, clinicians can and should be involved in the design process. Patient-Centered Design (PCD) is a method of customizing cognitive prosthetic software for use as a therapist’s tool in treating patients. The patient is viewed as a user with rapidly changing software needs. PCD can be used to personalize the software fast enough to be an appropriate therapy tool. Two mini case-studies are presented. One used almost no features yet overcame a barrier to achieving a significant therapy goal. The second shows the significant role of therapist and patient in designing a powerful new tool that enables patients to remind themselves, in their own words and voices, of upcoming events. The paper also relates advances in neuroscience to new clinical opportunities for cognitive assistive technology.
“Cognitive Prosthetics: an overview to a method of treatment”
The first survey article of the cognitive prosthetics area. Describes the different approaches of researchers in the field, various findings and techniques, and develops criteria for a cognitive prosthesis compared with software meant for the general population.
“Design and Outcomes of Computer-Based Cognitive Prosthetics for Brain Injury: A Field Study of Three Subjects”
A ‘schedule engine’ is used in very different ways for different patients. 3 plateaued outpatients used computers installed in their homes for 2-3 months. All exceeded expectations, and achieved both increases in level of functioning targeted by the study as well as a generalized increase on neurobehavioral and psychological dimensions. Patients were able to make substantial contributions to the design of their prosthetic software.
“Interface Design as a Prosthesis for an Individual with a Brain Injury”
1990 SIG CHI Bulletin. Data is presented from the first 314 days of use of 2 prosthetic software applications by a 3-year post-TBI woman with some profound deficits. Nonetheless, the client was able to make significant contributions to the design of her prosthetic software, and was able to develop unanticipated functionality for the software. Interface design was able to have the patient use both applications independently of caregivers.
“Rapid functional improvement and generalization in a young stroke patient following computer-based cognitive prosthetic intervention”
Severe physical and cognitive deficits showed dramatic improvement in both targeted and untargeted problem areas. This extended abstract was presented at an NIH Neural Prosthetics Workshop.
Click here for our papers and presentations; many can be downloaded.