Assistive Technology and Cognitive-Behavioral Programs for Promoting Adaptive Skills of Persons with Alzheimer Disease: A Selective Review

Background: Person with Alzheimer Disease may present cognitive, social, communication, physical, and orientation impairments. Furthermore, individuals with Alzheimer Disease may exhibit challenging behavior, isolation, and passivity. Objectives: To emphasize the role of Assistive Technology-based interventions and Cognitive-Behavioral Programs to improve the independence, and the quality of life of patients with Alzheimer Disease. To assess the effects on teaching adaptive responding, and decreasing challenging behaviors. Method: A selective literature review was carried out considering Alzheimer, Assistive Technology, Cognitive-Behavioral Programs, Adaptive Responding, Challenging Behaviors, and Quality of life as keywords. Twenty-six studies were reviewed. Results: Empirical data demonstrated the effectiveness, and the suitability of the selected interventions, although few failures occurred. The participants involved significantly increased their adaptive responding during the intervention phases, and maintained their performance over the time. Conclusion: Assistive Technology-based rehabilitative programs and Cognitive-Behavioral Interventions may be helpful for promoting the independence and the quality of life of individuals with Alzheimer Disease. DOI : 10.14302/issn.2470-5020.jnrt-18-2258 Corresponding author: Fabrizio Stasolla, University "Giustino Fortunato" of Benevento, Italy, Email: f.stasolla@libero.it Running title: AT and Alzheimer


Introduction
Alzheimer Disease (AD) is a irreversible neurodegenerative decline, which commonly includes a general loss of cognitive functioning, memory impairments, a deterioration of communication skills, an increased difficulty to performing daily activities, disorientation, and challenging behavior (e.g., wondering, urinary incontinence) [1][2][3][4]. Additionally, AD may have social-emotional negative outcomes such as depression, withdrawal, and passivity (i.e., physical inactivity) [5][6]. Accordingly, persons with AD may experience a growing negative impact on their quality of life [7][8]. Two basic categories of interventions have been up to date assessed for reducing the decline deterioration of AD, namely (a) pharmacological treatments, and (b) behavioral strategies [9][10]. The pharmacological approach relies commonly on three different types of interventions, that is (a) the use of anti-oxidants (e.g., Vitamin E), (b) the use of acetylcholinesterase (e.g., donepezil and rivastigmine), and (c) memantine, and the use of the N-methyl-Daspartate receptor-antagonist [11][12]. The empirical evidences indicate that the anti-oxidants can have positive effects on the progression of the disease (i.e., slow down), but do not improve the individual's cognitive functioning [13]. The other treatments may have beneficial consequence on the cognitive functioning but do not increase the independence of the person in her daily life [14]. interventions [17][18].
Cognitive-behavioral interventions may be useful and helpful for restoring the acquisition of the awareness concerning specific skills (e.g., daily activities). Thus, depending on person's level of functioning, one may rely on different rehabilitative programs, with different goals [21].
For instance, Fang et al. [22]   A basic form of AT devices, which may ensure the aforementioned process based on a learning process are microswitches (i.e., electronic tools capable of detecting small behavioral responses and delivering contingently brief periods of pleasant stimuli automatically through a system control unit) [29]. Four studies were included in this section with 35 participants involved (see Table 1) [30][31][32][33].
For example, Lancioni et al. [30] conducted two studies for helping six patients with moderate to severe AD to prevent their isolation and passivity. Specifically, Study I adopted an intervention to help three patients exercise an arm-raising movement. Study II adopted a program to help three participants exercise a leg-foot movement. The targeted response of Study I consisted of raising both arms/hands (i.e., moving them upwards).  with beneficial effects on their positive participation, and constructive engagement [49]. Five studies were included in this section, with 37 participants involved (see Table 4) [50][51][52][53][54].
Lancioni et al. [53] exposed four participants with moderate AD to a computerized-assisted    Approaches that may be adopted to deal with the urinary incontinence problem involve the regular of diapers and other absorbent aids, timed voiding, and prompting voiding [55]. Five studies were retained in this section with 149 participants included (see Table 5) [56][57][58][59][60]. Barrett The objective indicators seemed to be critical in evaluating the suitability and the effectiveness of behavioral interventions. Self-determination and independence of the participants were enhanced and the caregivers burden decreased.

Discussion
These findings were largely supported by previous contributions [61][62][63], and suggested the following considerations.
First, AT-based interventions may be viewed as great educational, psychological, and rehabilitative resources. In fact, they prevent isolation, withdrawal,  personalized for fostering their adaptation to each participant. One may argue that by designing a customer-tailored solution, the user may largely benefit of the learning process, with significant outcomes in daily contexts [66][67].
Third, because the challenging behaviors were reduced, one may argue that the patients positively redirected their efforts. That is, rather than self-stimulated, they were positively occupied and constructively engaged in new occupational tasks (e.g., picturing and/or coloring) and no more needed to be engaged in wandering. Otherwise, one may claim for an outside stimulation, which encouraged the participants and provided them with an adequate extrinsic motivation. The alarms/prompts were useful for enabling the participants with the acquisition of the awareness of an imminent urinary necessity and activated them for a specific request [68][69].