Tenth Annual Coleman Institute Conference

The Power of Partnerships
In Cognitive Disability & Technology


Posters representing work that is or has been partially supported by the Coleman Institute are Noted With an Asterisk (*).

RERC-ACT Projects*

Axelson, P.:  Development of Uniform Standards for Cognitive Technologies [ppt, 365kb]

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Principal Investigator: Peter Axelson, MS, ME
Beneficial Designs, Inc
Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies

The Development of Uniform Standards for Cognitive Technologies project will first identify aspects of technology that have implications for people with cognitive disabilities and then draft objective, technical standards that allow designers to meet the needs of this population. Ease-of-use standards for consumer electronics, the internet, software applications, and household appliances can make a high-tech society accessible to people with cognitive impairments. The standards will also allow the project team to create a consumer reporting system that will let people match the diverse features they need to products on the market. User and caretaker surveys are underway to determine the products of highest priority for this population. The recently established RESNA Standards Committee on Cognitive Technologies will serve as the official home for these standards.

Bodine, C.:  The Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies [ppt, 1.5mb]

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Principal Investigators: Cathy Bodine, PhD, CCC-SLP, University of Colorado Denver, Anschutz Medical Center, Assistive Technology Partners
Clayton Lewis, PhD, University of Colorado Boulder
Michael Lightner, PhD, University of Colorado Boulder

The Rehabilitation Engineering Research Center for Advancing Cognitive Technologies targets the almost 23 million American's who have some form of cognitive disability. Our focus is on research and development of cognitive technologies for this community across the life span, with a goal to increase the quality of life of this community, their families and caregivers; expand inclusion in all aspects of life and work; and to increase independence.

Our efforts are focused in three main areas. First, a product usability testing facility to focus rigorous industry-standard product testing protocols on cognitive assistive technology. This will allow us to disseminate detailed usability studies, engage our core community in testing to rigorously determine features which cause products to succeed or fail. The testing and evaluation capability will be integral in all development projects. Second, we are developing a core software/sensor platform to support mobile animated agents used for multiple applications. Third, we are focusing on developing Standards; a critically missing link for cognitive technology Information Technology access and technologies.

Bodine, C.:  Assistive Technology Partners [ppt, 1.5mb]

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Executive Director: Cathy Bodine, PhD, CCC-SLP, University of Colorado Denver, Anschutz Medical Campus

Assistive Technology Partners is designed to support individuals and community agencies to stay abreast of the ever changing, quickly evolving field of assistive technology.

ATP provides technical assistance, assessments and evaluations, an equipment loan bank, educational opportunities and assistive technology demonstrations to individuals and agencies across Colorado.

ATP also works to improve the integration of assistive technology devices into the lives of people with disabilities from a diverse set of perspectives:

  • Clinical studies research
  • Assistive technology product development and consultation
  • Industry standards development
  • Development of clinical assessment and outcomes management tools
  • Measuring the impact of systems change initiatives

Assistive Technology Partners is a proven leader in numerous development projects, and participates in these projects from the initial design phase, through individualized testing, to final technology transfer for commercialization.

Assistive Technology Partners staff includes research and engineering team members with a long track record of implementing research projects. Team members include faculty specializing in assistive technology, computer architecture, digital media production, rehabilitation engineering, biostatistics, and software and hardware development.

The research and engineering department works closely with leading universities, professional organizations, and industry partners to:

  • enhance educational opportunities
  • expand research capabilities
  • inspire innovative technological developments

Heyn, P.:  Non-Linear Context-Aware Prompting System (N-CAPS) for Persons with Cogntive Disabilites [pdf, 549kb]

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A 12-month pilot feasibility study. A novel device prototype based on a Non-Linear Aware Prompting System (N-CAPS), will be studied to identify whether context aware technologies have applications for individuals with cognitive disabilities in the workforce. The investigation will explore the feasibility of implementing a technology system in the workplace that uses Context Aware Prompting System (CAPS) to act as a job coach/training aid for adults with cognitive disabilities.

Landauer, T., Lewis, C.:  Theory and Simulation-based Vocabulary Development for Employment: An Analysis of the Word Maturity Method for Adult Workers with Mild Cognitive Impairments [ppt, 363kb]

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Principal Investigators: Tom Landauer, PhD, Clayton Lewis, PhD
University of Colorado Boulder
Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies

Today, some people with cognitive disabilities are not qualified for some jobs because of difficulty with vocabulary. This project is studying a new technique for vocabulary enhancement, to see if it is useful for increasing employment opportunities and enhancing job performance. The approach adapts the Word Maturity Method for vocabulary development, which is turn is based on the Latent Semantic Analysis technique for representing the meanings of words and sentences. The technique uses "test and teach" cloze items that can be used both to assess the learner's understanding of a target vocabulary word, and to give the learner information about what the word actually means. (A cloze item is a sentence with a blank; the student is asked to choose a word that best fills the blank.)

Lewis, C.:  Inclusive Collaboration Technology for Employment and Participation [ppt, 239kb]

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Principal Investigator: Clayton Lewis, PhD
University of Colorado Boulder
Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies

Increasingly, projects of all kinds are carried out by groups of people scattered across the country, or the world, using phone or computer-based collaboration tools to do their work. Unfortunately, people with cognitive disabilities are rarely included in these projects, even when the projects concern them. In part this exclusion results from the difficulty in following what is happening these meetings, and in contributing to them. For example, it can be difficult to signal that one wants to speak, or to get help from another participant when needed to understand a complex question. Our aim is to shape collaboration tools and practices to give people with cognitive disabilities the same ability to effectively participate in group discussions as people without disabilities.

McGrew, G.:  Usability Testing of Assistive Technology Products and Commercial Products with AT Applications [ppt, 884kb]

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Principal Investigator: Greg McGrew, ME University of Colorado Denver, Anschutz Medical Center Assistive Technology Partners Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies

Much of this project is devoted to evaluating the usability of products used by people with disabilities. Our interest in this stems from the significant number of assistive technology products that are abandoned shortly after being acquired. One contributor to this is the apparent lack of good human factors design in many products for people with disabilities. This can undermine the user's ability to effectively and efficiently use the product.

Formal usability testing involves capturing real users (people with disabilities that represent the target market for the AT or consumer product) using the product, attempting to accomplish tasks for which the product was designed. We will, for example, be asking caregivers and parents of children with speech difficulties to set up an AAC product for their child's use. During the test, we will record this activity. This will enable us to identify problems, difficulties, and missteps made by the participant, and analyze them to determine what design features or documentation may have contributed to their cause. Usability metrics are applied to each test. These include the number of errors, time-on-task, success/non-success, and efficiency. In addition, a standardized measure of usability is applied through administration of the System Usability Survey developed by IBM. Satisfaction is also assessed through administration of a short post-test survey. Statistical significance of results is supported by the number of participants included in any one product test. Valuable results may be obtained engaging anywhere from 5 to 20 participants, depending on the goals for the particular test. Our plan is to conduct such testing on 50 products during the life of the project.

Melonis, M.:  Non-Linear Contest-Aware Prompting System (N-CAPS) for Adults with Cogntive Disabilites in the Workplace [ppt, 1.1mb]

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Principal Investigator: Mike Melonis, BS
University of Colorado Denver, Anschutz Medical Center
Assistive Technology Partners
Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies

The Non-linear Context-Aware Prompting System for Adults with Cognitive Disabilities in the Workplace project integrates non-linear prompting, animated agents, context-aware sensors, battery-less power sources for sensors, automated video recognition, and complex mathematical modeling to create a solution intended to assist people with cognitive disabilities to succeed in the workplace. The specific aim of this project is a substantial increase in the number individuals with cognitive disabilities successfully placed in the workforce and a reduction in the number of hours a job coach is required to assist the employee. This past year the focus has been on work place environment analysis and system design. The poster has a small montage of the over 60 Unified Modeling Language diagrams produced during the analysis and design phase, and the key system components.

Sandstrum, J.:  Early Development Skills Acquisition and Socially Assistive Robotics (SARS): A Pilot Investigation of Effectiveness (R6) [ppt, 2.79mb]

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Principal Investigator: Jim Sandstrum. MA
University of Colorado Denver, Anschutz Medical Center
Assistive Technology Partners
Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies

The role of play in early childhood is universally recognized as a critical foundation for cognitive and social development. For most children opportunities to interact with the world are plentiful as they reach, roll over and later crawl, then toddle around their environments; as mobility and communication improve so do the opportunities to practice familiar skills and to develop new ones. For children with delayed motor and communication skills the opportunities to learn about their world are comparatively scarce.

It is for this nexus that socially assistive robotics holds promise. Caregivers and therapists naturally engage in social interactions with infants and toddlers such as games of peek-a-boo, positioning toys within read and "baby-talk". Unfortunately toys themselves are much less intelligent requiring the child to independently initiate and direct play. It is hoped that properly developed robotics paired with environmental sensors can bridge this gap to provide increased opportunities for these types of interactions.

This pilot specifically seeks to broaden the body of research on socially assistive robotics to include very young children (12-24 months) with significant developmental delays in the areas of communication and movement. The research will utilize the prototype robotic system engineered through The Socially Interactive Early Childhood Robotics (SAR) Project (D5) development project to investigate play-based interactions between the child and the robot. The study will target three areas in particular including 1) the efficacy of the robot in regards to increasing target behaviors in the child, 2) the robustness of the underlying controls system(s) used to process sensor input and to direct responses on the part of the robot, and 3) the fidelity of the model of human – robot interaction which directed the development of the prototype.

Sears, A.:  Cognitive Decline, Work and Technological Interruptions [ppt, 231kb]

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Principal Investigator: Andrew Sears, PhD
University of Maryland Baltimore County
Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies

While much research has focused on developing models of interruptible moments, often leveraging multiple sensors or physiological data (e.g., papillary response), the goal of the current research is to understand differences in how younger and older adults deal with and recover from interruptions. The research extends earlier efforts on interruptions during interactions with information technologies by explicitly addressing the influence of the changes in cognitive skills that are often associated with aging. Our initial studies focus on the software development process and investigate the effects of age-related declines in cognitive function on the programmers' ability to manage interruptions as well as the strategies employed to recover from these interruptions. Our goals are to designing new technologies to more effectively support this recovery process.

van Vuuren, S., Ngampatipatpong, N., Bowen, R., Struemph, T.:  Cognitive Technologies at Work and Home: Providing Anthropomorphic Assistance [ppt, 763kb]

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Sarel van Vuuren PhD1,2, Nattawut Ngampatipatpong2, Robert Bowen2, Taylor Struemph2

1 Assistive Technology Partners, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver
2 Interactive Assistance Lab, CLEAR/Institute of Cognitive Science, University of Colorado Boulder

We present results of the first year in an ongoing 5-year project to develop cognitive technologies for work and home. Project D2 in the NIDDR Rehabilitation and Engineering Research Center on Advancing Cognitive Technologies (RERC-ACT: Bodine et al, 2009) is part of an ecosystem of collaborative projects to design, develop and evaluate non-linear context-aware prompting technologies to help people with cognitive disabilities manage and overcome procedural and soft-skills challenges at work and home. Braddock et al (2004) estimates the U.S. population of people with cognitive disabilities at more than 20 million people. In project D2 specifically, our focus is to provide a personalized experience by adding a "human dimension" to the computer interface that improves, directs and encourages success: in short, providing anthropomorphic assistance (Van Vuuren, 2007).

To provide anthropomorphic assistance we leverage our previous work in personalized learning and virtual therapy: multimodal and interactive state-driven interfaces for assistance, and configurable and authorable state-aware interfaces for supervision (Cherney et al, 2008; Wise et al, 2008; Lee et al, 2009), conversational animated agents with accurate visual speech: based on articulatory phonetics (Ladefoged, 1993; Van Vuuren, 2007, 2008) and asynchronous approaches to network-centric PC, web and mobile application delivery (Van Vuuren & Ngampatipatpong, 2009).

Here we describe work to develop interfaces for anthropomorphic assistance as part of a collaboration with project D3 (Melonis et al) that is developing a non-linear context-aware prompting system for an assembly task (Bodine et al, 2009).


Bodine, C., Lightner, M., Lewis, C et al, (2009). RERC on Advancing Cognitive Technologies (RERC-ACT). National Institute on Disability and Rehabilitation Research under the US Department of Education, Grant #H133E090002: Available: http://rerc-act.org

Braddock, D., Rizzolo, M., Thompson, M. Bell, R. (2004). Emerging Technologies and Cognitive Disability, Journal of Special Education Technology. 19(4), Fall 2004. Retrieved as: http://www.colemaninstitute.org/article_braddock_1.pdf

Cherney, L. R., Lee, J. B., Hurwitz, R., Ngampatipatpong, N., Van Vuuren, S. (2008). Treating Aphasia over the Internet: A Clinical Trial, Annual Convention of the American-Speech Language Hearing Association (ASHA), Chicago, IL.

Ladefoged, P. (1993). A Course in Phonetics. Harcourt Brace Jovanovich. Third Edition.

Lee, J. B., Kaye, R. C. and Cherney, L. R.(2009). Conversational script performance in adults with non-fluent aphasia: Treatment intensity and aphasia severity, Aphasiology, 23:7, 885-897.

Van Vuuren, S. (2007). Technologies that power pedagogical agents. Educational Technology., 24:1, 4-10.

Van Vuuren, S. (2008). Animated Agent with Accurate Visual Speech for Learning on the Web, Innovation Seed Grand Program, University of Colorado Boulder Graduate School. Online: http://innovation.colorado.edu

Van Vuuren, S. & Ngampatipatpong, N. (2009). Interactive Learning Assistants for Online and Mobile Accessibility, 1st IEEE conference on Accessing the Future, Boston.

Wise, B., Van Vuuren, S., Ngampatipatpong, N. (2008). Initial Outcomes of Preliminary Computer RTI Study, 59th Annual Conference of the International Dyslexia Association, Seattle, WA.

Scientist in Residence Projects*

Lewis, C.:  Mainstream ICT and People with Cognitive Disabilities [ppt, 1.05mb]

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The 2008 Coleman Institute Workshop gathered representatives from industry, academia, government, advocacy, law and policy to discuss how harnessing mainstream technologies, especially Web and mobile technologies, could aid in meeting cost and performance goals for ICT. The workshop members identified needed developments in technical work, standards and regulation, research, and organization.

Lewis, C.:  Web Technologies and People with Cognitive Disabilities [ppt, 1.05mb]

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The 2009 Coleman Institute Workshop explored emerging research projects, industry developments, and international standards and practices that have the potential to support inclusive and accessible Web technologies for people with cognitive disabilities. The workshop members identified key challenges and potential strategies for making Web content more accessible and comprehensible, especially on mobile devices.

Lewis, C.:  Implications of Cloud Computing for People with Cognitive Disabilities [ppt, 1.05mb]

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The 2010 Coleman Institute Workshop, held in partnership with the Silicon Flatirons Center for Law, Technology, and Entrepreneurship, brought together leaders from industry, education, public policy, disability advocacy, and government to explore opportunities for shaping our national infrastructure for improving the lives and increasing independence of people with disabilities, particularly cognitive disabilities. The workshop members discussed potential benefits, opportunities, and challenges of cloud computing; technical opportunities and commercial infrastructure; and legal and regulatory barriers to accessibility technology in the cloud.

Hoehl, J:  Twitter

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Twitter is an online social network that enables its users to send and read short text-based messages to other users called "tweets." The 2010 Coleman Institute Conference will be using the "#cic10" hash tag to allow conference attendees to communicate with each other and offer comments, highlight interesting thoughts, take notes, link to online resources, and share ideas with other attendees and those not able to attend.

Hoehl, J:  Presenting Mobile Webpages on Desktop Browsers to Improve Access

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This poster explores the ability to take the mobile-optimized versions of webpages and provide them through a desktop browser. In doing so, simpler and streamlined versions of pages can be provided to improve access to those that may have difficulty in using the desktop-oriented functionality of a website.

Center for Aging Projects*

Hiroto, K., Qualls, S., Feliciano, L.:  Multisensory Stimuli and Dementia: Mitigating Wandering Behaviors and Promoting Engagement

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Kimberly E. Hiroto, M.A., Sara H. Qualls, Ph.D., & Leilani Feliciano, Ph.D.
Department of Psychology, University of Colorado at Colorado Springs

The movement to create home-like environments for persons with dementia reflects the conceptual shift toward recognizing the person with dementia rather than just the disease. Consistent with this person-centered care, the present study applied the theory of personhood (Kitwood, 1993) and the concept of the person-environment fit (Lawton, 1983) to reframe wandering behavior in dementia as a form of movement through space. This study explored how interactions between personal and environmental characteristics impact the experience and use of space among 10 residents living in a secured unit for persons with dementia. Researchers installed multisensory stimuli within one hallway of this unit with the aim of fostering pro-social, positive engagement among residents. Multisensory stimuli were categorized as either familiar (e.g., video of babies playing) or novel (e.g., colored gel tiles) and as primarily engaging visual or tactile senses.

A single-subject, ABACA withdrawal design was used to examine the duration of time that residents spent with the stimuli during intervention phases (with stimuli present) versus baseline (no stimuli) and how residents engaged with stimuli during these moments. Results showed that a minority of residents used the hallway space and even fewer engaged with stimuli, partly because few residents lived along this hallway. Importantly, staff played a crucial role in residents' engagement with stimuli.

Examining the behavioral profiles of the three residents who used the stimuli most frequently revealed several themes within this project about the interpersonal relationships between residents and staff members and the importance of considering their unique and shared experiences within this hallway space. The residents profiled here demonstrated preferences for the visual stimuli of forests and babies playing. Residents' behaviors also suggested that their preferred stimuli fit with their personal preferences and/or functional and cognitive abilities. This study demonstrated the importance of considering residents' and staff members' personal characteristics as well as environmental access when designing applied studies in care environments. Moreover, results from this exploratory study suggested that the construct of the person-environment fit needs to consider the multiple interactions between the resident with dementia, their care provider(s), and their objective and subjective experiences of this shared care environment.

Layton, H., Shear, S.:  The Effects of Self-monitoring by Staff Who Care for those with Cognitive Disabilities [ppt, 631kb]

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Heidi Layton, M.A. & Stewart Shear, Ph.D.
The Devereux Foundation

Overview and Purpose
Direct Care Professionals (DCPs) provide the majority of daily care to individuals with cognitive disabilities who live in a group home setting. Multiple behavioral strategies have been used to support staff in their daily job duties, and self-monitoring is one such strategy. Self-monitoring has been shown to aid in increasing DCPs awareness to the associated task being monitored (Burgio, Whitman, & Reid, 1983). Therefore, when self-monitoring data recording, it was hypothesized that DCPs would have a greater awareness to the variables associated with the data being collected. Such as, if a DCP is required to document each occurrence of self injurious behavior, self-monitoring will increase awareness to the self-injurious behavior, which will lead to greater tracking of the behavior and better intervention planning. The current study added another variable to promote self-monitoring. Performance feedback, given to maintain accuracy in the self- monitoring protocol, was used to ensure understanding and supervision of the design (Hughes, & Lloyd, 1993). Overall, the research questions proposed were: Would self-monitoring increase the daily data recordings completed by DCPs? And, did feedback provided to the supervisor increase the completion of daily data recordings by DCPs?

Three community group homes were chosen based on clinician referral. All homes had data recordings below an 80% completion rate. A total of 29 DCPs worked in the three homes, and all agreed to participate in the study.

A self-monitoring protocol was developed for the current study. It was designed to have DSPs mark "complete" or "not my responsibility this shift" next to four daily data recording tasks.

A single subject multiple baseline design was used to evaluate the effects of the self-monitoring protocol on daily data recordings. The study had three phases, baseline, intervention and maintenance, each lasting 3 or more weeks. After the baseline phase, DSPs were trained on the use of the data recording protocol. Thereafter, the protocol was completed at the end of every shift. After using the protocol form for at least three weeks, supervisors were given feedback as to the staff members who were completing the protocol forms in their homes. During the maintenance phase, all data recording protocols were removed from the home, and supervisor feedback was no longer provided.

Results and Discussion
Overall findings were idiosyncratic to each home. Home 1 showed significant improvement during the intervention phases. Home 2 had significant variability and low treatment integrity, while Home 3 had low variability and high treatment integrity. Results suggest that self-monitoring can aid in data recording, but there are additional variables that may aid in the usefulness of this paradigm. Therefore, future studies are needed to look at the effectiveness of supervisory feedback and self-monitoring, as well as the social validity and acceptability of self- monitoring by DSP.

Burgio, L. D., Whitman, T. L., & Reid, D. H. (1983). A participative management approach for improving direct-care staff performance in an institutional setting. Journal of Applied Behavior Analysis, 16, 37-53.
Hughes, C., & Lloyd, J.W. (1993). An analysis of self-management. Journal of Behavioral Education, 3(4) 405-425.

Qualls, S., Medved, B., Kenney, M., Crumlin, J., Bryan, L., Williams, A.: Cognitive and Psychological Screen (CaPS): Early Detection of Cognitive Impairments in Older Adults [ppt, 450k]

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Becky Medved and Sara Qualls, UCCS and Peak Aging, Inc.

This brief self-administered screening software is delivered on a touch-screen computer that delivers a brief report of areas of concern that warrant full evaluation. The software is designed for use in primary care where regular screens to test for cognitive and mental health challenges are a key component of public health efforts. Early detection is needed prior to the point when a patient or family member may inform primary care (or other helpers) that they see problems in daily living. Current strategies used in primary care have poor rates of detection because they are of necessity very brief due to time constraints. This screen is fully self-administered, uses assessment tools recommended for early detection, and is in final testing for reliability and validity (data will be completed within 2 months). The screen has been in use in the local community health center's senior clinics during its development, so also has strong clinical validity. The software is ready for beta testing.

Williams, A., Ervin, D., Hatfield, D., Harris, J., Qualls, S.:  Building a Behavior Support Program at a Community Centered Board: Three Years of Collaboration [ppt, 989kb]

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A. Williams, Ph.D., D. Ervin, M.B.A., D. B. Hatfield, Ph.D., BCBA-D, J. Harris, Ph.D., & S. H. Qualls, Ph.D.

The Resource Exchange (TRE), a community based organization coordinating a continuum of services to individuals with intellectual disabilities throughout El Paso, Park, and Teller counties in Colorado, partnered with the University of Colorado at Colorado Springs' Psychology Department, with the financial support of The Coleman Institute for Cognitive Disabilities in 2007 to create a Behavioral Health Service Delivery System for adults with intellectual disabilities. At that time, a licensed and highly experienced psychologist in the community was sought to guide the development of the system's theoretical frame and to teach and supervise graduate psychology students for a one-year externship. The vision of the collaborators was to build a system through which (a) high-quality behavior support services (resulting in high-quality outcomes) could be delivered to individuals in their natural environments; and (b) TRE could provide a rigorous and high-quality training experience. In its second year, the original partnership was expanded to include an APPIC Clinical Internship site through the University of Colorado Denver School of Medicine. Interns in this rotation receive didactic training in integrated care, and bi-directional learning opportunities occur when interns present health services projects related to their major rotations to the intern class. Also during the second year, the benefits of contracting with paraprofessionals led TRE to hire a part-time line therapist who has expertise in language acquisition of individuals who are non-verbal. In its third year, a post-doctoral fellowship was added, creating a pipeline of students from the graduate to post-graduate level of training. Over the course of the program, approximately 20 clients with a broad range of intellectual functioning and diverse behavior support needs have been treated. Timelines of treatment have ranged from a few weeks for individuals who needed stabilization during crisis situations to several years for those whose behaviors have changed through multiple steps, beginning with community safety skills to current work on building social and occupational skills. Treatment goals have included language acquisition, social skills training, increasing community access, reducing self-injurious behavior, and physical and verbal aggression, to name a few. Referral sources have included TRE case managers (Community Coordinators), local service agencies, parents, and guardians. The primary treatment modality has been Applied Behavior Analysis, including diverse established interventions, such as Picture Exchange Communication systems and CIRCLES social skills training. Case summaries demonstrate the effectiveness of intervention and treatment progress and common treatment barriers. Multiple considerations impact the financial feasibility of developing a non-profit, government-funded service delivery model. Fiscal considerations include identifying sources of revenue, management of initial modest financial costs, similar to the start-up of a business, and the value of making a measurable difference in the lives of adults with intellectual disabilities. Future directions of TRE's Behavioral Health Service Delivery System include the movement toward an Integrated Health Care model involving additional community partners.

Vair, C., Qualls, S., Doffing, M., Williams, M.:  Communication Patterns of Aging Familes: The Role of Technology in Assisted Living Facilities

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C.L. Vair, S. H. Qualls, M. Doffing, & M. D. Williams, Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO 80933.

The placement of an older adult in an assisted living (AL) facility alters the role that family members undertake in the day-to-day lives of their aging loved one including interactions and communication patterns. Families show reciprocal support with older adults, and maintain connections within and across generations, yet older adults living in long term care are at high risk of depression and loneliness which likely results from disconnection from previous social networks. This study assesses the impact of one device designed to facilitate communication between residents of ALs and their families. The Family Connections Service (FCS) allows AL residents to send print or photos in a a one-touch digital mailbox with the assistance of staff in three assisted living facilities., This poster reports on the patterns of interactions between older adults living in ALs and family members interfacing with their preferred technology. Data on frequency of communication, range of persons communicating with the elder, and family and staff perceptions of usability as well as measures of impact on elder and family well-being will be used. The present study describes the initial data on the recruitment of older adults and family members and utilization launch and patterns. Findings are interpreted as demonstrating the acceptability of the technology, and the value to the families as well as the AL staff that accrues from more frequent communication with a larger range of the residents' networks.

JFK Partners Projects

Blakely-Smith, A., Reaven, J., Leuthe, E., Culhane-Shelburne, K., Moody, E., Hepburn, S:  Incorporating Technology Into a Pilot Cognitive Behavioral Group for Adolescents with High Functioning Autism Spectrum Disorders and Anxiety

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Audrey Blakeley-Smith, Ph.D., Judy Reaven, Ph.D., Eileen Leuthe, Ph.D., Kathy Culhane-Shelburne, Ph.D., Eric Moody, Ph.D. & Susan Hepburn, Ph.D.

Individuals with developmental disabilities are at increased risk for developing anxiety disorders and children and teens with high-functioning autism and Asperger Syndrome are at even greater risk for developing significant anxiety symptoms (Brereton, Tonge & Einfeld, 2006). Anxiety can be a debilitating disorder as symptoms can markedly interfere with an individual's ability to participate in home, school and community activities. Cognitive-behavioral therapies (CBT) are frequently used for children and adolescents with anxiety symptoms in the general population with good success. Given the common co-occurrence of anxiety and autism spectrum disorders (ASD), it is surprising that so few treatment studies of dually diagnosed persons exist in the literature. Recently published treatment studies have demonstrated reductions in anxiety symptoms for children with ASD, following modified CBT group interventions (Chalfant, Rapee, & Carrolll, 2006; Reaven, Blakeley-Smith, Nichols, Dasari, Flanigan & Hepburn, 2009; Sofronoff, Attwood and Hinton, 2005). However, none of the studies published to date have specifically targeted adolescents with ASD. Given the understudied and underserved nature of this population, the research focus in the autism community must now turn to adolescents as scores of children with ASD are maturing. Thus, the purpose of the current program of research was to expand our intervention program for children with ASD and anxiety (Face Your Fears: Group Therapy for Children with High-Functioning Autism Spectrum Disorders and Anxiety; Reaven et al., in press) to adolescents with ASD and anxiety.

The specific aims of the current study were to modify the Face Your Fears program for high school students with ASD (ages 14-18) and clinically significant anxiety, to assess the acceptability and feasibility of the group treatment for adolescents and their parents, and to conduct initial efficacy studies using our modified treatment protocol in reducing adolescent anxiety symptoms.

Innovation in intervention may be key to maintaining adolescents' interest and motivation for treatment. One such innovation in the current protocol was the addition of Personal Digital Assistants (PDA's) coupled with cognitive-behavioral strategies. Information regarding the use of the PDA (and later the Apple iPod Touch) will be presented.

A description of the expanded intervention program will be presented, along with pre-post assessment data on 19 adolescents who participated in the group treatment.

Hepburn, S:  Telehealth Delivery of a Family Focused Intervention Program for Children with Autism Spectrum Disorder and Anxiety [doc, 83kb]

Robinson, C., Scharer, G., Moody, E., Rosendahl, S., Acha, K., Pfenninger, K.:  IDDRC Translational Neuroscience Nexus for the Study of Intellectual and Developmental Disabilities [pdf, 3.74mb]*

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Cordelia Robinson, PhD, RN; Gunter Scharer, MD, PhD; Eric Moody, PhD; Sondra Rosendahl, MS; Kathy Acha, MS; Karl Pfenninger, MD

The IDDRC Translational Neuroscience Nexus (Nexus) functions as a searchable database, patient registry and linked biological sample bank focused on a broad range of intellectual and developmental disabilities (IDD). The goals of the Nexus include the following: to advance research and treatment of IDD; to provide data for future research studies; to identify links between genes, cognition and behavior; to facilitate access to appropriate patient cohorts for clinical trials; and, to promote new and competitive research programs at the University of Colorado Denver. Individuals with IDD and family members of individuals with IDD can participate in this study. Researchers affiliated with the IDDRC can utilize our clinical data registry and/or linked biological sample bank for studies focused on IDD. We can provide consultation services including clinical study design assistance, biostatistics support, and IRB protocol consulting and support. Additional information can be found at our website (http://medschool.ucdenver.edu/iddrc) or via e-mail (iddrcnexusregistry@ucdenver.edu).


Mulligan, J., Xu, W., Jeong, J.:  Use of Virtual Exercise Environments for People with Disabilities [pdf, 513kb]

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Jane Mulligan, Wei Xu, Jaeheon Jeong
Computer Science,
University of Colorado at Boulder

Virtual reality (VR) can transport people to real or imagined worlds and allow them to meet or compete with friends in distant locations. As a result it offers a unique approach to addressing the exercise needs of people with disabilities. The goal of this project is to develop compelling augmentations for standard exercise equipment, such as treadmills, stationary bikes, or arm ergometers, which can engage users and encourage them to participate in regular exercise programs.

Kinetic interfaces like the Wii and the XBox Kinect have the potential to promote fitness, but the question remains whether they can engage users in the long term and provide the motivation to achieve fitness goals. Studies indicate that augmentations which provide an external attention focus for users, tend to increase both enjoyment and intensity or duration of exercise. More detailed analysis of design features for exercise games which would motivate adoption and adherence to exercise programs, emphasize nurturing less skilled players, supporting their goals and facilitating grouping with friends and peers in spite of their lack of experience.

Currently the prototype VEE consists of a recording system to capture video as well as distance and incline data about real trails, and a playback system which "displays" both video and terrain data in the form of video speed and machine resistance. The latest system blends 3 1920x1080 (HD) views into a 110° horizontal field of view panorama for display on one or more large format screens.

Generating high quality wide angle panoramas poses several technical challenges. The first step is to estimate the physical geometry of the camera positions in order to compose the individual frames into a single panoramic image. For regions where two frames overlap image parallax can cause nearby objects to appear twice because their image position differs for each frame (viewpoint). Further because of differences in viewpoint and lighting and even small hardware differences the image appearance (color, brightness, etc) can vary between frames. We continue to work on the problems of blending and color correction for our panoramic sequences. For panoramic video from unsynchronized cameras, the additional problems of temporal frame alignment and jitter stabilization arise.

On the display side we have developed a new large format playback system for the VEE which exploits the (relatively) low cost and availability of large-format HDTVs as the viewing hardware. In virtual reality the larger the display the more immersive the feeling of the environment. We are using the latest Microsoft Media Foundation tools to control our wide angle panoramic videos and view them on a display panorama consisting of 3 large screen HTDVs mounted in front of our cardiovascular exercise equipment.

The next steps for the VEE involve integrating more social aspects to the system since the research suggests this is critical to adherence. We plan to add Voice over IP (VoIP) and the ability to "exercise with a buddy" in the virtual trail environment.

Other Projects

Abrams, D.:  Delivering Liquid Drug Forms Direct to Brain to Optimize Effectiveness*

View Abstract

Daniel J. Abrams1, 2

1 Departments of Psychiatry and Neurosurgery, University of Colorado, Denver, School of Medicine, and 2 ICVRX, Denver

Many people with serious Central Nervous System (CNS) diseases suffer profoundly and have limited options for improving their condition. Consider that one of few treatments for refractory epilepsy is lobectomy – removal of a brain lobe – despite grave risks and side effects. An option not yet tried is delivering medication to the exact disease location, called compartmental drug targeting, which has worked in asthma and cystic fibrosis. Given the nature of CNS diseases, such targeting is ideal because, unlike oral administration, it can automatically give smaller doses consistently through the day without the need for patients to remember to take medication. Already, spinal medications (over 150,000 patients) are delivered directly and automatically, with pumps. These are provided through specialized compounding pharmacies that serve doctors and patients under state board oversight and related existing FDA labeling. ICVrx will first apply this approach to improve the lives of refractory epilepsy patients: 600,000 people (U.S.) for whom oral meds don't work and who are open to current surgical options but deterred by their high cost and, for lobectomy, the consequences of irreversibility. At the company's core is patent-protected technology for formulating available drugs for direct delivery to the brain using implantable pumps. The company is at a clinical stage, ready to use its technology in clinical studies.

Agnew, J., Gabriels, R., Pan, Z., Holt, K., Martin, S., Clayton, J., Ruzzano, S., Bosler, H., Bosler, H., Mesibov, G.:  Therapeutic Horseback Riding in Children with Autism Spectrum Disorders [pdf, 205kb]

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*Agnew, John A.; Gabriels, Robin L.; Pan, Zhaoxing; Holt, Katherine; Martin, Sydney; Clayton, Jerry; Ruzzano, Selga; Bosler, Heather and Howard, Rebecca, Mesibov, Gary

University of Colorado at Denver/The Children's Hospital, Department of Psychiatry, Aurora, CO 80045

Background: Therapeutic horseback riding (THR) has been used to enhance functioning in many individuals with disabilities in Canada and the U.S. for over 40 years, but few studies have evaluated such interventions scientifically. Children diagnosed with an autism spectrum disorder (ASD) have social, communication, behavior, emotional, and dependency issues and caregivers struggle to find helpful interventions for these children.

Objectives: Evaluate effects of 10 one-hour weekly lessons of standardized THR treatment in three core areas: 1) Self-regulation behaviors, 2) adaptive daily living skills, and 3) motor coordination, organization and planning. Compare changes made following THR intervention with changes made during a ten-week waitlist control period, occurring immediately before THR.

Methods: Forty-one subjects (35 male, 6 female) between the ages of 6 – 16 years (mean age: 8.7 years) with an ASD received pre- and post-intervention evaluations including the Aberrant Behavior Checklist-Community (ABC-C), Vineland Adaptive Behavior Scales-II (VABS-II), Bruininks-Oseretsky Test of Motor Proficiency (BOT-II) and Sensory Integration and Praxis Test (SIPT) within one month prior to and following engagement in 10 weeks of THR lessons. Caregivers completed ratings (ABC-C) of the child's behaviors on a weekly basis. Sixteen subjects also participated in a wait-list control group before THR.

Results: Subjects from the THR group demonstrated significant improvements on the Irritability, Lethargy, Stereotypic Behavior, Hyperactivity and Inappropriate Speech subscales of the ABC-C; Short Form of the BOT-2; SIPT Verbal Praxis and Communication raw score and Adaptive Total score of the VABS-II. For the Irritability, Lethargy, Stereotypic Behavior and Hypersensitivity subscales of the ABC-C, significant improvement was noticed as early as the third week of THR. The expressive and receptive language subdomain raw scores of the VABS-II Communication domain were examined and subjects displayed significant improvement on the measure of expressive language, but there was a trend towards improvement on receptive language.

The waitlist control group enabled further analysis of the data to determine if the improvements were due to THR or if they might be due to a different, unidentified factor. ANCOVA analyses were performed to compare the change from pre-test to post-test. Significant improvements were found in subjects who participated in THR vs. waitlist period on the Irritability, Lethargy, Stereotypic Behavior and Hyperactivity subscales of the ABC-C.

Conclusions: The presence of a significant difference on the ANCOVA analysis suggests that the degree of change from the pre-test to the post-test differs significantly between the waitlist and the THR conditions and, therefore, may be due to the treatment itself. Lack of significant results on this ANCOVA analysis could mean that any differences observed on the t-tests described above may be due to developmental changes, lack of statistical power to identify a significant difference using the ANCOVA analysis or other factors that cause fluctuations between testing sessions.

Sponsor: The Children's Hospital Research Institute (Funds donated by Greenspring Christian Church)

Ahmed, M., Dubach, D., Sturgeon, X., Costa, A., Gardiner, K.:  Pathways Perturbations in Mouse Models of Down Syndrome*

View Abstract

Md. Mahiuddin Ahmed, Daphne Dubach, Xiaolu Sturgeon, Alberto Costa, Katheleen Gardiner

Department of Pediatrics, Neurosciences and Human Medical Genetics Programs, The Intellectual and Developmental Disabilities Research Center, University of Colorado Denver.

Down syndrome (DS) is the most common genetic cause of intellectual disability. It is caused by an extra copy of human chromosome 21 (HSA21) and the increased expression, due to gene dosage, of the genes it encodes. This overexpression is predicted to cause widespread perturbations in protein profiles in brain and other tissues. To identify potential targets for pharmacotherapies it is necessary to characterize these perturbations. Here we describe results of protein profiling in two mouse models of DS, the TC1 (Transchromosomal) model, which is trisomic for ~100 HSA21 genes, and the Ts65Dn model, which is trisomic for a partially overlapping set of 89 HSA21 genes. We are using Reverse Phase Protein Arrays (RPPA) to assay levels and dynamic changes in phosphorylation and localization of key proteins involved in NMDAR, MAP kinase and calcineurin signaling and apoptosis pathways in these mouse models, and in response to Context Fear Conditioning and memantine treatment. In the course of this work, we identified patterns in protein phosphorylation that are sensitive to methods of protein lysate preparation that include use of heat and kinase inhibitors to inactivate enzymes involved in protein modification.

Brannon, S., Donahoo, W., Gozansky, W., Coussons-Read, M.:  Evidence Links Obesity with Increased Risk of Cognitive Decline and Dementia

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Sarah Brannon, William Donahoo M.D., Wendee Gozansky, MD MPH, and Mary Coussons-Read, PhD.

A growing body of evidence links obesity, particularly central obesity, with increased risk of cognitive decline and dementia. However it is clear that not all people who are obese experience cognitive impairment. Individual risk may be shaped by alterations in glucose metabolism, hypothalamic-pituitary adrenal (HPA) axis function, pro-inflammatory cytokines and neurotrophin levels. The contribution of modifiable risk factors to the maintenance and protection of cognitive function needs further investigation, for in an aging and increasingly obese population protective factors may provide valuable opportunities for prevention. Research agenda: To investigate behavioral factors that may modulate adult cognitive function, clarify potential mechanisms and so develop a stronger evidence base on which to build effective prevention programs and interventions. Our current research towards this goal involves two studies. Study 1 uses cross-sectional data collected from 5138 adults aged 20-59 years as part of the Third National Health And Nutrition Examination Survey (NHANES-III) to determine whether a) adiposity and cognitive function are linked in early and mid-adulthood and b) the relationship is mediated or moderated by behavioral factors such as diet, physical activity and social support. We hypothesize that with increasing age central adiposity will be more strongly linked to cognitive function than body mass index (BMI), and that this trend will be modulated by behavioral factors and physiological markers of inflammation, glucose regulation and hormone profile. Study 2 compares the effects of two dietary interventions found to improve cognitive function in animal models on the cognitive function of obese adults. Twenty-five obese adults were randomized to 8 weeks of either a standard calorically restricted diet (-400kcal) or Intermittent Fasting (IF), in which subjects ate ad libitum one day but fasted completely the next. At baseline, week 1 and week 8 inpatient visits, measurement of BMI, fat mass, serum glucose, insulin, lipids, inflammatory markers (IL-6, CRP & TNF-a), brain-derived neurotrophic factor (BDNF), and diurnal free cortisol were made. Effects of diet on cognitive function have yet to be analyzed, but we hypothesize that the IF dietary regimen will be associated with improvements in systems already known to affect cognitive function, including insulin sensitivity, inflammation, HPA axis function and BDNF. Implications: Cognitive function affects every aspect of health and well-being, and contributes significantly to quality of life across the lifespan. A better understanding of factors that modify risk of cognitive decline has the potential to aide efforts at primary and secondary prevention of mild cognitive impairment and some dementias.

Dubach, D., Sturgeon, X., Gardiner, K.:  Protein Pathway Peturbations in Down Syndrome Lymphoblastoid Cell Lines

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D Dubach, XL Sturgeon, K Gardiner, Dept Pediatrics, Intellectual and Developmental Disabilities Research center, University of Colorado Denver, Aurora, CO.

Down syndrome (DS), resulting from an additional copy of human chromosome 21 (HSA21), is the most common genetic cause of intellectual disability (ID). Due to the large number of genes encoded by HSA21 (~160 confirmed protein coding genes), it is likely that numerous pathways and cellular processes are affected. Our goals are to identify proteins whose expression levels, phosphorylation status or subcellular localizations are altered due to trisomy 21 and to determine which abnormalities are most critical for learning and memory deficits in DS. We are exploring the utility of lymphoblastoid cell lines (LCLs), derived from white blood cells from controls and individuals with DS, as a model system. Compared with mouse models of DS, LCLs have the advantages of providing complete trisomies of HSA21 and a more economical and continuously renewable source of material that can easily be manipulated with drug treatments. We are searching for neurologically relevant protein abnormalities expressed in LCLs.

By screening protein lysates from LCLs generated from eight DS and eight controls, we have demonstrated that levels of the HSA21 encoded superoxide dismutase (SOD1) were significantly increased in DS. Increased SOD1 levels have been shown to increase levels of H2O2. Indeed, we found that expression levels of glutathione reductase (GSR) and catalase were also increased in DS LCLs. GSR is frequently used as an indicator of oxidative stress whilst catalase functions as a H2O2 reducing enzyme. Based upon our findings thus far, we predict that the DS LCLs are under increased levels of oxidative stress. Additional perturbations in the DS LCLs include elevated levels of phosphorylated GSK3β which lead to decreased levels of GSK3β kinase activity. Numerous targets of GSK3β include tau, glycogen synthase and β-catenin. We have also identified age-dependent differences in DS-related abnormalities.

To inform our experimental efforts, we are also using bioinformatics approaches for data mining in curated public databases to predict novel abnormalities relevant to DS. Of interest, the TRAIL (tumor necrosis factor-related apoptosis-inducing ligand) pathway was found to contain four HSA21 proteins as components (DSCR1, APP, TIAM1 and COL18A1) as well as have 34 HSA21 proteins interacting with its pathway components. Four proteins in the TRAIL pathway have been associated with intellectual disability. It has been established that TRAIL expression is increased in Alzheimer's disease (AD) brains, in particular in proximity to Aβ plaque deposits. As the brains of individuals with DS exhibit AD-like neuropathology later in life, this pathway is of interest for further analysis. Because some TRAIL pathway proteins are expressed in LCLs, DS relevant abnormalities can be assayed in this system.

By using a combination of experiments and bioinformatics, we are gaining exciting novel insights into protein pathway alterations in DS, assessing the inter-individual variation in these alterations and predicting additional perturbations that may exist in the DS brain. These results will provide the basis for predicting novel potential drug treatments to be tested in these and other DS model systems.

Funding: Coleman Institute for Cognitive Disabilities, the Anna and John J Sie Foundation, the Fondation Jerome Lejeune, and the National Institute of Child Health and Human Development,

Freed, C., Luong, N., Zhou, W.:  Huntington Disease Neurons Derived In Vitrofrom Human Patient Fibroblasts Using Adenoviral Vectors*

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Curt R. Freed, MD, Nancy Luong and Wenbo Zhou, PhD
Departments of Medicine, Pharmacology, Neurology, and Neurosurgery; the Neuroscience Program; the Biomedical Sciences Program, the Regenerative Medicine and Stem Cell Biology Program; Â University of Colorado School of Medicine, Aurora, CO 80045, USA.

The recent development of human induced pluripotent stem cells (iPS cells) from somatic cells has made it possible to model genetic diseases in vitro. Yamanaka and colleagues in Kyoto have opened up a new dimension for stem cell research by showing that fibroblasts can be reprogrammed to pluripotent stem cells that share many of the characteristics of embryonic stem cells. Our laboratory has expanded this technology to show that adenoviruses can be used to insert transforming vectors into human fibroblasts and produce iPS cells. Because adenovirus is not incorporated into the genome, our method eliminates the risk of ongoing expression of genes such as c-myc. Now that adult fibroblasts can be reprogrammed, it is possible to create stem cells from an individual person with a genetic disease of the nervous system and model that disease in vitro. This methodology provides a completely new strategy for studying diseases like Huntington's disease. We have reported the successful generation of integration-free human iPS cells using adenoviral vectors expressing c-Myc, Klf4, Oct4, and Sox2. We have used these vectors to convert fibroblasts from two Huntington disease patients identified by the Coriell repository as GM21756 from a 30 year old female with 70 CAG repeats. The second subject is GM09197, a 6 year old male with 180 CAG repeats. The large mutation accounted for his very early disease onset. From the iPS colonies of these two subjects and from a normal control subject, we have used differentiation to embryoid bodies as well as differentiation factors to induce neuroprogenitor cells as well as cortical and striatal neurons.

Graw, S., Freund, R., Floyd, K., Dell'Acqua, M., Leonard, S.:  Deficits in a Measure of Memory, known as Long-Term Potentiation, are Dependent on Nicotine Receptors and Genetic Background

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1Sharon Graw PhD, 2Ron Freund PhD, 1Kirsten Floyd BA, 2Mark Dell’Acqua PhD, 1,2Sherry Leonard PhD.
1Department of Psychiatry; 2Department of Pharmacology, University of Colorado Denver

Cognitive deficits are a core feature of schizophrenia, a neurodevelopmental disorder that affects approximately 1% of the population. People with schizophrenia have demonstrated deficits in multiple domains of cognition which have proven refractory to treatment with antipsychotic agents used to treat positive symptoms of the disorder. Defects in cognition in schizophrenia precede psychosis and are primary determinants of community functioning. Thus, the importance of cognitive symptoms in schizophrenia, combined with their resistance to current treatments, has led to the need for the increased identification, characterization, and understanding of the molecular bases of neurocognitive pathways. Here, we describe a mouse model with cognitive deficits, and demonstrate that these deficits depend on genetic background.

The α7 neuronal nicotinic receptor (α7*) is known to play a role in the development of schizophrenia through linkage analyses, association studies, endophenotype characterization, and gene copy number variation (CNV) studies. The receptor is a homopentameric ligand-gated ion channel expressed in multiple neuronal and non-neuronal cell types, with both a presynaptic and postsynaptic localization. Activation of the α7* receptor on neurons leads to an influx of calcium and increased neurotransmitter release. Postsynaptically, it is associated with regulation of gene expression. The α7 subunit is encoded by the CHRNA7 gene in humans and by the Chrna7 gene in mice. Neuronal nicotinic receptor type and distribution have been evaluated in multiple mouse strains, and C3H and C57BL/6J wild-type mice have similar levels of the high-affinity α4β2* receptor, while C3H mice have significantly elevated levels of the low-affinity α7* receptor compared to C57BL/6J. Chrna7 knockout animals have been shown to have cognitive deficits by the 5-choice serial reaction test. Notably, the NIMH MATRICS Initiative has ranked α7* nicotinic receptor agonists as the most "promising target for development of a drug to treat cognitive impairments in schizophrenia."

Long-term potentiation (LTP) is a reflection of synaptic plasticity and a model for learning and memory. Multiple transgenic and knockout mouse studies have shown that mutations associated with impaired LTP lead to deficits in learning. LTP was examined in the hippocampal CA1 region of C3H and C57 Chrna7 wild-type, heterozygous, and homozygous knockout mice. Wild-type C3H animals demonstrated robust LTP, while homozygous knockout animals had minimal and heterozygous animals intermediate levels of LTP. Both wild-type and Chrna7 knockout C57 mice had reduced levels of LTP compared to C3H wild-types, but did not significantly vary from each other. Differences in LTP in the two mouse strains may be due to the lower levels of the α7* receptor in C57 wild-type mice. Paired-pulse ratios did not differ significantly in C3H wild-type, C3H knockout, and C57 wild-type mice, indicating no difference in probability of glutamate release.

In summary, LTP impairment in Chrna7 knockout mice is dependent on genetic background. These strain differences in LTP imply that diverse genetic backgrounds in humans might affect the outcome of low levels of CHRNA7 expression. Through these studies we will gain a better understanding of the molecular interaction between reduced α7* receptor activity and genetic background on synaptic plasticity and a cellular model for learning and memory. Ultimately, these studies will generate candidate genes that may contribute to the cognitive pathology observed in human schizophrenic subjects.

Gunderson, J.:  Personal Robots and Cognitive Disabilities

Kramer, H., Harris, J.:  13th Annual Conference on Accessible Media, Web & Technology

View Abstract

On November 15-19, UDAC and ODECE at CU-Boulder will host the 13th annual Accessing Higher Ground: Accessible Media, Web & Technology Conference at the Westin Hotel in Westminster. The conference focuses on the benefits of Web Standards and Universal Design for Digital Media along with strategies for making campus information resources accessible for students with disabilities and effective for all audiences.

Visit this poster session to learn more about the conference, about Universal Design for digital media and about the activities of UDAC – the Universal Design & Accessibility Committee of CU-Boulder. Also learn about an upcoming 3-credit course on Universal Design for Digital Media to be offered at CU-Boulder in the spring of 2011.

Lewis, H., Dise-Lewis, J.:  Concussion in High School Athletes: Data and Implications from 3 Years of Computerized Neuropsychological Testing [pptx, 221kb]

View Abstract

Hal C. Lewis, Ph.D.
Associate Professor, UCD SOM
Departments of Psychiatry and Pediatrics
JFK Partners, Colorado’s UCEED

Jeanne Dise-Lewis, Ph.D.
Associate Professor, UCD SOM
Department of Physical Medicine and Rehabilitation
The Children’s Hospital of Denver

Over a period of three years, Grandview High School, a large suburban high school in Aurora, Colorado collaborated with researchers from University of Colorado Denver and The Children's Hospital of Denver on a grant from the Center for Disease Control (CDC) to follow and study the effects of concussion on student athletes. Approximately 1,000 athletes participated in pre-season computerized neuropsychological testing using the group administered ImPACT system. Just over 100 of them subsequently sustained concussions (percentage consistent with other national estimates of concussion in high school contact sports) and took one or more additional administrations of the ImPACT until their key index scores returned to baseline levels. The data presented in this poster indicate 1) that patterns of neuropsychological recovery from athletic concussion may be quite different from subjective reports of symptoms that are usually relied upon in "return-to-play" decisions and 2) there may be indicators in the health history and/or recent symptoms reports of athletes regarding vulnerability to concussion. Comparisons with "control subjects" who did not have concussions during the season are presented in terms of ImPACT index scores, health history, and report of recent symptoms. Implications for prevention of sports-related concussion and management of concussion in high school athletes are discussed. Additionally, the potential utility of computerized neuropsychological testing systems and computer-based cognitive rehabilitation systems with this population are discussed.

Radulescu, A.:  Frequency Spectra of fMRI Time Series Identify Prefrontal Dysregulation in Schizophrenia

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Anca Radulescu, Mathematics Department, University of Colorado at Boulder

Both theory and experimental evidence suggest that complex living systems self-organize and function close to the boundary of chaos, with erroneous organization to an improper dynamical range (too stiff or too chaotic) underlying system-wide dysregulation and dis- ease. We hypothesize that this erroneous organization may also characterize psychosis in paranoid schizophrenia, via optimization abnormalities in the prefrontal-limbic circuit regulating emotion. We acquired fMRI scans from 35 subjects (N=9 patients diagnosed with DSM-IV paranoid schizophrenia and N=26 healthy controls), while they viewed affect-valent facial stimuli. To quantify dynamic regulation, we analyzed the power spectrum of fMRI time-courses. Patients showed distinct spectra than controls { di er- ence localized to the anterior prefrontal cortex (Brodmann Area 10) and represented by a profile of frequencies close to white noise in patients and ranging from pink to brown noise in controls. Our results cohere with a large body of work finding pink to brown noise to be the normal range of central function at the synaptic, cellular, and small network levels, and suggest that patients show less supple regulation of this region. Brodmann Area 10 is consistent with previous work in schizophrenia, which implicates this area in deficits of working memory, executive functioning, emotional regulation and underlying biological abnormalities in synaptic (glutamatergic) transmission.

Sikela, J., Keeney, J.:  DA Sequence, DUF1220*

View Abstract

Jonathon Keeney, Graduate student
Jim Sikela/Diego Restrepo laboratories
Neuroscience Program
University of Colorado Anschutz Medical Campus

The Sikela lab has previously identified a DNA sequence, DUF1220, that shows a striking human-specific increase in copy number (>250 copies in human; 1 in mice/rats) and may be involved in human brain evolution. Most copies of DUF1220 map to human chromosome 1 in the 1q21.1 region and interestingly a number of recent reports have implicated copy number variations that occur in this region in several cognitive diseases: autism, schizophrenia, microcephaly, macrocephaly, neuroblastoma and other forms of cognitive disability. A model has been proposed that these diseases are a by-product that has resulted from the evolutionarily rapid increase DUF1220 sequences that has occurred recently in the human lineage. To begin to study DUF1220 domains we have been developing transgenic mice that carry human copies of DUF1220 domains. Such humanized mice will provide the first living animal model for the investigation of DUF1220 function.

Stevens, K., Zheng, L., Abrams, D.:  Central Administration of Clozapine in DBA/2 Mice: Continuous Versus Daily Injections

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Central administration of clozapine in DBA/2 mice: continuous versus daily injections

Karen E. Stevens1,2, Lijun Zheng1 and Daniel J. Abrams1,3

1 Department of Psychiatry, University of Colorado, Denver, School of Medicine; 2 Medical Research Service, Veterans Affairs Medical Center, Denver, and 3 ICVRX, Denver

Deficits in sensory inhibition are a common feature of schizophrenia and are thought to underlie the patient's poor attention and problems with learning and memory. The DBA/2 inbred mouse models this deficit. Most antipsychotic medications do not improve this deficit, however the atypical antipsychotic does, it also improves the deficit in DBA/2 mice when administered acutely. We have shown that acute administration of clozapine directly into the lateral ventricle of the DBA/2 mouse also improves sensory inhibition similar to that seen with acute systemic injections. The present study assessed chronic ventricular administration versus daily ventricular injections of clozapine for its ability to improve sensory inhibition in the DBA/2 mouse.

Sturgeon, X., Ngoc, T., Gardiner, K.:  Pathways to Intellectual Disability in Down Syndrome [ppt, 718kb]*

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1Xiaolu Sturgeon, 2Thanh Le Ngoc and 1Katheleen Gardiner
1. Department of Pediatrics and the Intellectual and Developmental Disabilities Research center, 2. Department of Computer Science and Engineering, University of Colorado Denver

Human chromosome 21 (HSA21) encodes approximately 160 classical protein coding genes, five microRNAs and an additional >350 genes of unassigned function (Sturgeon et al 2010). Over expression of these genes, as in Down syndrome, will result in complex perturbations of multiple processes involved in neurological development and function. While several recent reports have shown pharmacological rescue of learning and memory deficits in a popular mouse model of DS (the Ts65Dn), this model is trisomic for fewer than 100 HSA21 proteins. Development of safe and effective pharmacotherapies for the cognitive deficits in DS requires an understanding of pathway perturbations in a full trisomy HSA21. We are using a systems neuroscience, pathway-based approach, not only to understand non-HSA21 molecular abnormalities observed in DS and mouse models, but also to predict additional abnormalities and potential responses of these systems to drug treatments. The subset of pathways relevant to intellectual disability (ID) in DS are termed DS-ID pathways and are defined as those pathways with components and/or interacting proteins that include HSA21 proteins and one or more ID proteins, proteins known to be involved in ID from mutation analysis in human subjects. Pathway component data have been obtained from the curated pathway databases and ID proteins have been identified from the Online Mendelian Inheritance in Man database (OMIM) and the literature. Pathways were then extended by adding primary interaction data obtained from the curated protein interaction databases, filtered for co-expression and common cellular compartment. Extended pathways were scored based on the proportion of their components and interactions that are HSA21 and ID proteins. Inspection of the resulting set of DS-ID pathways showed the following: (i) few pathways include HSA21 proteins as components; rather DS-ID pathways are heavily impacted by interactions with HSA21 proteins; (ii) perturbations in nerve growth factor (NGF) and Sonic Hedgehog (SHH) signaling, observed in the Ts65Dn, are predicted from pathway associations of ID and HSA21 components and interactions; (iii) perturbations of similar significance are predicted in glucocorticoid, interferon, insulin and ErbB signaling, and apoptosis pathways;. (iv) a small number of HSA21 proteins, including APP, TIAM1, ITSN1, SUMO3, ITGB2 and S100B, impact a large number of pathways; and (v) the majority of pathways, including those listed above, are influenced by proteins mapping throughout HSA21 and include those whose orthologs are not trisomic in the Ts65Dn, emphasizing the likelihood that the molecular basis of drug responses in the Ts65Dn will be different in human DS. All pathway data are available and searchable by pathway, protein or interaction protein name at: http://gfuncpathdb.ucdenver.edu/iddrc/hsa21gdpw/home.htm.

This work was supported by the Coleman Institute for Cognitive Disability, the Fondation Jerome Lejeune, and the Anna and John J Sie Foundation.

Tanis, S.:  SD.Futures: Self-Directed Employment Exlporation and Attainment for Students with Intellectual Disabilities [ppt, 1.45mb]

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The Individuals with Disabilities Education Act (P.L. 105-17) extended previous legislation by indicating the importance of providing employment-related activities during high school. However, despite federal legislation designed to support students with disabilities as they transition from school to adulthood, many youth with intellectual and developmental disabilities face the reality of unemployment and underemployment upon graduation (Hughes, 2008; Metzel, Boelzig, Butterworth, Sullewski & Gilmore, 2007). The dilemma that many transition programs face is that high schools persistently miss the mark in their quest to provide adolescents with disabilities the social, vocational, and self-determination skills to become competitively employed (Rusch, Hughes, Agran, Martin & Johnson, 2010). The proposed project will provide schools with the tools to enable students to self-direct their own learning and identify desired post-school outcomes through an interactive web-based curriculum guiding them toward meaningful employment.

Funded by the U.S. Department of Education, the Girls at Work Project at the Kansas University Center on Developmental Disabilities has combined best practices in the enhancement of self-determination skills and supported and customized employment for young women with disabilities in the creation of the Self-Determined Career Development Model (SDCDM) (Wehmeyer et al., 2003). Based on the SDCDM a self-directed computerized curriculum focusing on the exploration and attainment of nontraditional employment and/or postsecondary education was developed. Initial data of the project including 40 young women with developmental disabilities across 13 Kansas high schools indicate that out of 18 women who have graduated from high school in the past year 83% were either employed or attending postsecondary education. The proposed project is a collaboration between the Coleman Institute for Cognitive Disabilities and the Kansas University Center for Excellence in Developmental Disabilities and seeks to expand and improve the Girls at Work curriculum so that all students, male and female, and those with more significant disabilities may be able to access the curriculum. The project will add features and activities to the existing curriculum allowing it to become gender neutral and enhance the accessibility features of the curriculum by placing the content on a more flexible web-based platform. New features will include cross-browser and platform compatibility based on user preference, video and audio lesson options, gender neutral activities, outcome measurement tools, secure social networking options, and on-going feedback loops. Upon the completion and revision of the curriculum, students enrolled in 18 to 21 school programs in the states of Kansas and Rhode Island will pilot the curriculum over the course of a school semester to evaluate the accessibility and functionality of curriculum and measure outcomes achieved as a result of engaging with the curriculum.

Tomberg, S., Rogers, C.:  Developmental Disability Online Training for First Responders

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S. Tomberg, C. Rogers
University of Colorado School of Medicine, Aurora, Colorado

This project is designed to improve interactions between first responders (emergency medical technicians, fire & police departments) and members of the developmental disability community–primarily those with Autism Spectrum Disorders (ASD). Nationally there is increasing awareness and education in the first responder community concerning the dramatic increase in prevalence of ASD diagnoses, but in Colorado the educational efforts are sporadic and not centralized. The goal of this project is to bring Colorado standards up to the best in the nation.

We researched available national resources and discovered the State of New Jersey implemented a mandatory online course that trains first responders for their interactions with people with developmental disabilities. We partnered with the New Jersey Office of Emergency Medical Services and Rutgers University and were given permission to modify this course to be Colorado specific. JFK Partners and the Autism Society of Boulder County both provided funds to make the course available to all first responders in state free of charge. Both organizations as well as several members of the first responder community provided guidance on course content. The University of Colorado Hospital agreed to make this program their inaugural offering for their emergency medical services online education program.

We are currently awaiting the launch of the program and consequently the data. We have a survey attached to the course, which will give us a way to track perceived competency, awareness, and confidence of the first responder in handling these encounters, both pre- and post-course.

It is our hope that not only will this project improve outcomes for sensitive populations in crisis scenarios in Colorado, but also that the model of partnership between EMS agencies and disability communities can be replicated elsewhere. If effective we would like to expand the use of the online training by making it available to other states.

UzZamen, N., Bigham, J., Allen, J.:  Multimodal Summarization for People with Cognitive Disabilities in Reading, Linguistic and Verbal Comprehension [pdf, 773kb]

Wachtel, H.:  Cumulative Neural Damage from Repeated EMF Pulses May Be Similar to that from G1 Concussions [doc, 27.5k]

View Abstract

Howard Wachtel
Professor of ECEE and of Neuroscience
University of Colorado Boulder

In recent years devices based on electromagnetic fields (EMF) have been deployed increasingly to study brain structure and function in patients and volunteer subjects. For example, commonly used Magnetic Resonance Imaging (MRI) involves applying to the head both a very strong static magnetic field (1.5 Tesla) and a pulsed "gradient" magnetic field having rapid onset and offset dynamics (as well as an RF field to resonate hydrogen ions). MRI technology has been of unquestionable diagnostic benefit to patients—and thus any risks from EMF exposure of the head have been considered to be acceptable. Newer technologies such as Functional Magnetic Resonance Imaging (FMRI), however, utilize even stronger fields (3Tesla or more for the static field as well as stronger and faster rising pulses for the "gradient" field). Typically, FMRI is used in brain research labs on "volunteer" subjects who derive no medical benefit from their repeated and often prolonged EMF exposures. Thus they are impacted with a much higher risk/benefit ratio than are standard MRI subjects (patients).

The long term effects of repeated exposures to pulsed magnetic fields in an FMRI machine are not well understood (or even well studied), but the short term effects may be compared to those of another recent neuro-technology TMS. Transcutaneous Magnetic Stimulation (TMS) is used, overtly, to stimulate neurons within the brain to fire action potentials (AP) at higher rates by inducing transmembrane currents. TMS has considerable potential for diagnostic or therapeutic purposes but it clearly carries with it a high risk of disrupting and damaging neuronal function. As such it is not appropriate for use on volunteers.

In both TMC and MRI techniques, the induced currents across neurons are proportional to the time rate of change (dB/dt) of the magnetic fields applied to the head. EMF pulses from newer models of machines used for FMRI are therefore quite capable of inducing currents similar in magnitude (and duration) to those used in TMC to overtly stimulate neurons. The stimulatory effect of such magnetically induced currents is also comparable to the immediate effects of moderate impacts to the head which cause Grade 1 (G1) concussions. Repeated G1 concussions have recently been associated with substantially elevated risks of early onset dementia (EOD) and it is quite possible that stimulatory fields from TMC or FMRI devices may have similar long-term consequences. Before the use of technologies such as TMC or FMRI are sanctioned for more widespread use, it behooves the scientific community to determine what risks for neural damage they carry and what can be done to ameliorate such risks.

Wachtel, H.:  Possible Neuronal Membrane Basis of Early Onset Dementia Due to Repeated G1 Concussions [doc, 27kb]

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Howard Wachtel
Professor of ECEE and of Neuroscience
University of Colorado Boulder

It has long been realized that severe blows to the head produce irreversible brain damage and decrements in cognitive function often leading to Early Onset Dementia (EOD). A classic example of this is the "punch drunk" boxer who has been knocked unconscious a few times. In such situations there are usually distinct physical and chemical changes in the brain and thus a clear picture of the underlying neural damage emerges even before severe cognitive changes occur.

More recently it has also become evident that a history of repeated "moderate" blows to the head (Grade 1 concussions) can also have cumulative effects possibly leading to EOD. However, in such cases, it is harder to pinpoint what structural or chemical changes in the brain have actually occurred. Lack of such diagnostic evidence has generally been taken to mean that no cumulative damage is occurring—often with the tragic outcome that G1 concussion sufferers are allowed to continue activities leading to recurrence of such traumas. A clear example of this (hopefully past) practice has emerged from recent studies of former NFL players who are now suffering extremely elevated rates of Alzheimer's Disease and other forms of EOD—while still in middle age. The once common practice of "shaking off the cobwebs and getting right back into the game" is now being reconsidered—not only for the NFL but in many other sports where moderate, but repeated, head trauma is common.

At what level is the damage due to G1 concussions occurring and why does it have a cumulative nature? One explanation is that damage is likely to be at a microscopic (sub-cellular) level. The neuronal cell membrane might be particularly vulnerable to such damage and as a result of small incursions may become more porous to the flow of the ions from the exterior to the interior milieu. If not too severe, such ion leaks can be compensated for by increased active transport of ions which is metabolically driven. This will serve to maintain optimum transmembrane ionic concentration gradients over fairly long times—and repeated microscopic insults However, as more damage to the membrane accumulates, the ability of this compensatory mechanism to overcome it is lessened. In addition, small decreases in cerebral blood flow and metabolism, which would not ordinarily be of consequence, start to take a toll. Eventually, a point is reached at which active transport can no longer keep up with the demand and the nerve cell malfunctions and soon dies. Unlike other tissues (muscle, bone, etc.) which can replace dead or damaged cells with new ones, brain cells cannot be replaced. So as the number of neurons that have been damaged (by G1 concussions) die off there is a gradual but irreversible decrease in cognitive and other neural functions—and this can eventually manifest itself as Early Onset Dementia.

AbleLink Technologies

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AbleLink Technologies, Inc., specializes in the research and development of Cognitive Support Technologies for people with intellectual and developmental disabilities, traumatic and acquired brain injuries, and age-related cognition issues. AbleLink's award-winning technologies provide solutions for access and independence for people with cognitive disabilities whose needs are not being consistently or comprehensively addressed in most universal design applications.

AbleLink provides an array of desktop and mobile applications that allow access to many everyday technologies, including cell phones, email, and the internet. AbleLink's extensive research and development work has resulted in cognitive support technologies that promote self determination and independence on the job, in the home, at school and in the community.

AbleLink Technologies
618 North Nevada, Colorado Springs, CO 80903



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In 2005, Imagine! launched one of its most ambitious projects ever - the development of two SmartHomes in Boulder County. The SmartHomes incorporate cutting edge residential technologies that enhance the quality of life for consumers, augment the effectiveness of staff as caregivers, and provide cost and energy savings for Imagine!.

Today the Bob & Judy Charles SmartHome in Boulder and the Charles Family SmartHome in Longmont provide permanent housing for individuals with physical, cognitive, and developmental disabilities. As the first such homes in the nation, the SmartHomes serve as a model for the future of residential care for people with cognitive disabilities. In addition, creating this new model of providing residential services has enormous potential to impact groups of people with related concerns (dementia, autism, chronic mental illness, Alzheimer's) through partnerships with other agencies.

Our SmartHomes are the product of years of initial research within in the field of assistive technology. As this research continues, the Imagine! SmartHomes Team has identified a number of technologies that are best suited to homes where one or two people needing support reside.

Our team will demonstrate and discuss various technologies including: RFID (radio frequency identification), Tele-Health remote monitoring and other approaches that we're currently researching.

Mentor InterActive Inc.

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Mentor InterActive is a publisher of games and software titles that promote the confluence of technology, educational and entertainment. Our mission is to improve the literacy and learning skills of children the world over with products that are enjoyable and engaging, use proven teaching techniques and research, and are available on readily accessible technology platforms, including videogames, mobile devices, and the web.

In late 2009 we released My Virtual Tutor™ Reading, a series of three age-graded Nintendo DS™ title aimed at providing literacy instruction for 4-7 year-olds. The games were based on work done by researchers at the University of Colorado at Boulder, developed by an accomplished and award-winning developer in 1st Playable Productions, LLC, and has to date won six awards and been met with critical praise.

In the fall of 2010 we are following up the success with My Virtual Tutor™: Reading with My Reading Tutor: Kindergarten to 2nd Grade for Nintendo DS™, a title the combines the best of the My Virtual Tutor™ series and delivers improved activities and lessons for the best in customer value.

In spring 2010 we released thinkSMART™ for the Nintendo DS™ and Wii™ to the U.S., a series of best-selling brain training games in Europe designed by the puzzles masters at Ravensburger. thinkSMART™ has received rave reviews from customers and the press.

In late 2010 we're gearing up to launch a new property, COSMOS CHAOS! for the Nintendo DS™, a new concept from the Pacific Resources for Education and Learning (PREL). COSMOS CHAOS! provides training for science and science vocabulary through an exciting role-playing-game format similar to Pokémon.

Rest Assured

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Name: Rest Assured, LLC
Address: 2000 Greenbush Street
  Lafayette, IN 47904
Contact: Dustin Wright
  General Manager
  877-338-9193 x 348

Rest Assured® is caring people using remarkable technology to help individuals to:

  • improve the quality of their lives
  • increase their independence, and
  • maintain their privacy, health and safety.

The Rest Assured® patented web-based Telecare system uses the latest wireless technology to offer their customers and their clients real-time interactive in home support services.

Rest Assured® services have been specifically designed to support adults who have cognitive, intellectual and developmental disabilities in order to help them grow, develop, and enhance the quality of their lives.