Alessandro O. Caffò

Video Prompting Versus Other Instruction Strategies for Persons With Alzheimer’s Disease

Background/Aim: Two studies assessed the effectiveness of video prompting as a strategy to support persons with mild and moderate Alzheimer’s disease in performing daily activities. Methods: In study I, video prompting was compared to an existing strategy relying on verbal instructions. In study II, video prompting was compared to another existing strategy relying on static pictorial cues. Video prompting and the other strategies were counterbalanced across tasks and participants and compared within alternating treatments designs. Results: Video prompting was effective in all participants. Similarly effective were the other 2 strategies, and only occasional differences between the strategies were reported. Two social validation assessments showed that university psychology students and graduates rated the patients’ performance with video prompting more favorably than their performance with the other strategies. Conclusion: Video prompting may be considered a valuable alternative to the other strategies to support daily activities in persons with Alzheimers disease.

Assistive technology for promoting choice behaviors in three children with cerebral palsy and severe communication impairments

A technology-based program to promote independent choice behaviors by three children with cerebral palsy and multiple disabilities was assessed. The program was based on learning principles and assistive technology (i.e., customized input devices/sensors, personal computers, screening of preferred stimuli according to a binomial criterion). The first purpose of the present study was to provide the participants with a new set-up of assistive technology and to allow them to choose among three categories (i.e., food, beverage and leisure), and to request a specific item out of four in each category, adopting a procedure that minimized (according to a conditional probability criterion) unintentional choices. The second aim of the study was to carry out the effects of the program on detectable mood signs (i.e., happiness index). The study was conducted according to an ABAB sequence with a subsequent post intervention check for each participant. The results showed an increase of engagement and of the happiness index during intervention phases. Psychological as well as educational implications were discussed.

Assessing human reorientation ability inside virtual reality environments: the effects of retention interval and landmark characteristics

The purpose of the present study was to assess the navigational behaviour of adult humans following a disorientation procedure that perturbed their egocentric frame of reference. The assessment was carried out in a virtual reality (VR) environment by manipulating the disorientation procedure, the retention interval, the relative positions of target and landmark. The results of experiment I demonstrated that adding a physical rotation to a virtual disorientation procedure did not yield an additional decrease in searching performance. The results of experiment II showed that shortening the delay between study and test phase decreased the errors more markedly for geometric than landmark ones. An orientation specificity effect due to the manipulation of the relative position between target and landmark was discussed across the experiments. In conclusion, VR seemed to be a valuable method for studying human reorientation. Moreover, the virtual experimental setting involved here promoted knowledge of the relationship between working memory and spatial reorientation paradigm.

Reorientation Deficits Are Associated With Amnestic Mild Cognitive Impairment

Background/Aims: Spatial memory can be impaired in amnestic mild cognitive impairment (aMCI). The present study investigates categorical spatial memory deficits using a virtual navigation-based reorientation task. Methods: Twenty-eight amnestic single domain and 23 amnestic multiple domain patients were compared with 53 healthy elderly controls on the performance of the virtual reorientation test (VReoT). Results: The reorientation performance of participants in both aMCI groups was significantly worse than that of controls suggesting that VReoT detects spatial memory deficits. No significant difference emerged between the 2 groups of patients. A subsequent receiver–operating characteristic analysis showed that a score of 8 had a sensitivity of 80.4% and a specificity of 94.3% (area under the curve = 0.90). Conclusion: The VReoT seemed to be accurate in differentiating patients with aMCI from controls and may represent an evaluation supplement for spatial memory deficits in prodromal stages of Alzheimer’s dementia.

Comparing two different orientation strategies for promoting indoor traveling in people with Alzheimer's disease

The present study compared two different types of orientation strategies: an assistive technology program (AT, i.e., remotely controlled sound/light devices) and a backward chaining procedure (BC) for promoting indoor traveling in four persons with moderate to severe Alzheimers disease (AD). A social validation assessment of the two strategies was also conducted employing undergraduate students as raters. For three out of four participants, AT intervention was more effective than the BC procedure, whilst for the fourth participant the two types of intervention had a comparably satisfying efficacy. A doubly Multivariate Analysis of Variance on social validation assessment data provided generally more positive scores for the AT intervention. These results suggest that AT programs (a) can be valuably employed for restoring and maintaining independence in indoor traveling in people with moderate to severe AD, and (b) might be perceived as preferable to conventional teaching strategies within daily contexts.

Technology-based orientation programs to support indoor travel by persons with moderate Alzheimer's disease: impact assessment and social validation.

The present study (a) extended the assessment of an orientation program involving auditory cues (i.e., verbal messages automatically presented from the destinations) with five patients with Alzheimers disease, (b) compared the effects of this program with those of a program with light cues (i.e., a program in which strobe lights were used instead of the verbal messages) with the same five patients, and (c) conducted a social validation assessment of the two programs with 70 university psychology students employed as social raters. Results confirmed the effectiveness of the program with auditory cues and showed an equally strong impact of the program with light cues with all five patients. The psychology students involved in the social validation assessment provided significantly higher scores for the program involving light cues on a six-item questionnaire. Those scores suggested that this program was perceived as a practically and socially preferable choice. The implications of the findings for daily contexts dealing with patients with Alzheimers disease are discussed.

Age and sex differences in a virtual version of the reorientation task.

Previous studies on allocentric frame of reference (FoR) have shown a substantial deficit in elderly spatial navigation. (e.g. Moffat and Resnick 2002). We referred to allocentric FoR in terms of the absence of reckoning cues in solving a spatial navigation task. Although age-related effect on navigational behaviour has been already evaluated in previous studies (e.g. Driscoll et al. 2005), rarely the impact of both layout and featural information has been systematically assessed. Acquisition and use of knowledge regarding the environment are fundamental to effective everyday functioning and, consequently, have a critical impact on the quality of life, particularly for elderly adults. A general aim of this study is to investigate the different weight of layout and featural information in a virtual version of reorientation paradigm (VReor) adopting an individual difference perspective. Virtual environments have been successfully employed in research involving both children (e.g. Newhouse et al. 2007) and elderly (Moffat and Resnick 2002). Benefits in the employment of virtual reality technologies can be summed as follows: (a) improvement in experimental control, with the advantage to create realistic, interactive three-dimensional environments, and to collect a large amount of reliable data, (b) maintained ecological validity with respect to real-world settings, (c) opportunity to investigate spatial navigation strategies in samples showing different characteristics, such as aged people and people with cognitive impairments and psychopathological conditions. In line with the aforementioned theoretical framework, this paper accounted for the following ideas: first, the layout information remains stable along lifespan, because it seems to be linked to a more implicit perception of space, the use of featural information is less stable along life-span, and it tends to corrupt earlier with age. Second, males rely predominantly on layout information, while featural information is used equally by both males and females.

Intervention strategies for spatial orientation disorders in dementia: A selective review

Purpose: This article provides a brief overview of the intervention strategies aimed at reducing spatial orientation disorders in elderly people with dementia. Methods: Eight experimental studies using spatial cues, assistive technology programs, reality orientation training, errorless learning technique, and backward chaining programs are described. They can be classified into two main approaches: restorative and compensatory, depending on whether they rely or not on residual learning ability, respectively. Results: A review of the efficacy of these intervention strategies is proposed. Results suggest that both compensatory and restorative approaches may be valuable in enhancing correct way-finding behavior, with various degrees of effectiveness. Some issues concerning (a) variability in participants’ characteristics and experimental designs and (b) practicality of intervention strategies do not permit to draw a definite conclusion. Conclusions: Future research should be aimed at a direct comparison between these two strategies, and should incorporate an extensive neuropsychological assessment of spatial domain.

The role of pre-morbid intelligence and cognitive reserve in predicting cognitive efficiency in a sample of Italian elderly

BackgroundModels of cognitive reserve in aging suggest that individual’s life experience (education, working activity, and leisure) can exert a neuroprotective effect against cognitive decline and may represent an important contribution to successful aging.AimThe objective of the present study is to investigate the role of cognitive reserve, pre-morbid intelligence, age, and education level, in predicting cognitive efficiency in a sample of healthy aged individuals and with probable mild cognitive impairment.MethodsTwo hundred and eight aging participants recruited from the provincial region of Bari (Apulia, Italy) took part in the study. A battery of standardized tests was administered to them to measure cognitive reserve, pre-morbid intelligence, and cognitive efficiency. Protocols for 10 participants were excluded since they did not meet inclusion criteria, and statistical analyses were conducted on data from the remaining 198 participants. A path analysis was used to test the following model: age, education level, and intelligence directly influence cognitive reserve and cognitive efficiency; cognitive reserve mediates the influence of age, education level, and intelligence on cognitive efficiency.ResultsCognitive reserve fully mediates the relationship between pre-morbid intelligence and education level and cognitive efficiency, while age maintains a direct effect on cognitive efficiency.DiscussionCognitive reserve appears to exert a protective effect regarding cognitive decline in normal and pathological populations, thus masking, at least in the early phases of neurodegeneration, the decline of memory, orientation, attention, language, and reasoning skills.ConclusionsThe assessment of cognitive reserve may represent a useful evaluation supplement in neuropsychological screening protocols of cognitive decline.

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

Abstract 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.