ProsthesisWare: A new class of software supporting the activities of daily living.

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Abstract
To use the microcomputer as a prosthetic tool in rehabilitation has a number of advantages over using it as a tutor for cognitive retraining. As a tool, the microcomputer program directly addresses ecologically relevant issues in activities of daily living. New classes of software like HyperCard (TM) and MacLaboratory Controller (c), can be readily customized for each patient's needs. Unlike tutors used for cognitive retraining, rehabilitation tools provide prosthetic support that does not presuppose any required reorganization or restructuring of damaged neural tissue. As this new approach to using microcomputers in rehabilitation is implemented, new types and styles of neuropsychological assessment will need to evolve, especially to provide sequential monitoring for adjustments to various iterations of the computer programs. We used the Macintosh (TM) computer with ProsthesisWare tools written in HyperCard for its ease and speed of design. The standard user interface relieves a patient's memory overburden by providing external function and sequencing cues. We present the case of Cecelia R., a patient with an expressive aphasia secondary to a traumatic brain injury. The development of successive approximations of a speech prosthesis for her-SpeakEasy (c), SpeakEasier (c), and SpeakEasiest (c)-illustrates how new hardware and software capabilities permit the rapid iterative design and redesign of cognitive prosthesis tools. This case also illustrates some limitations of the approach and new requirements that would be placed on the rehabilitation environment. We conclude that the emergence of ProsthesisWare constitutes a new application of microcomputers in rehabilitation that offers utilitarian prosthetic aids for the everyday activities of daily living for a select group of people with cognitive impairments.

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