Real artists ship

In a recent paper in Neuropsychological Rehabilitation, PDA and smartphone use by individuals with moderate-to-severe memory impairment: Application of a theory-driven training programme, Svoboda, Richards, Leach and Mertens describe the provision of mobile computing technology to ten people with acquired brain injury. Their participants engaged well with the technology and a rigorous ABAB design provided strong evidence that the intervention was effective for these participants. In somewhat of a departure from usual practice, this paper does not state the smartphone or PDA models that were used by the ten participants. The authors do reference individual case studies they had previously published about two of their participants. One of those case studies described the use of a Treo 680, while the more recently published case study did not report the actual technology used. In the absence of other information it seems likely that first generation smartphones like the Treo 680 were the newest devices used in the trial, and references to PDAs indicates some older Palm Pilot devices were also likely used. Perhaps device models were not described as the authors saw this as a potential distraction from the results, which they felt remain applicable to more recent technology.

I agree that findings based on earlier devices should certainly still be considered relevant, a point I make in a chapter in the forthcoming Oxford Handbook of Clinical Geropsychology, and which was also discussed by Gillespie, Best and O'Neill (2012). However, it remains possible that future research will demonstrate important differences in the effectiveness of one generation of technology over another. It is a pity that a clear description of the technology was not provided by Svoboda et al.—it was, after all, integral to the intervention. Even if reporting somewhat older technology, they remain in good company. At talks given to both the APS College of Clinical Neuropsychologists in Brisbane and to the University of Queensland School of Psychology last week I noted that as far as I am aware, no study to date has been published in neurorehabilitation that describes the use of modern touchscreen smartphones. This is despite it now being over five years since the Apple iPhone redefined this market in 2007. While studies with touchscreen devices are no doubt coming, this starkly reflects our disconnect: compared to the rate of evolution in technology, academic research is glacial.

The authors placed an emphasis in this paper on the training approach they used. Svodoba et al. used relatively intensive clinician input—an average of eight hours of individual training with the device per participant—and an errorless fading-of-cues protocol to train their participants to use their devices. (This is similar to the approach described in the Australian study that was the focus of the most recent Synapse Voices podcast with Belinda Carr and Natasha Lannin.) The training approach appeared well-considered and suitably based on theory and past research. It is worth reflecting that the authors did not actually test their belief that this rigorous training approach was necessary to generate the positive changes observed in their participants. The methodology used in the paper is only capable of demonstrating that such an intervention was sufficient to generate the change. It is not impossible that a less intensive training approach may have been equally effective, something it would be useful to examine in a future study.

Svodoba et al. are to be commended for using mainstream, shipping technology in their research. More than two decades of research into customized mobile computing devices as cognitive prosthetics has resulted in precious few devices or services that can be used in further studies by other research teams, let alone products that can actually be issued to clients to assist with their day-to-day difficulties. Steve Jobs, founder of Apple Inc., is reputed to have said, "Real artists ship". Though famed for a perfectionist attention to product design and interface detail, Steve Jobs understood something that too few people do—that value is only generated when a product is actually shipped for widespread use. By focussing their research on mainstream technology and services, Svodoba et al. are setting an example that all of us should follow. Rehabilitation needs actual shipping products.