Medically Reviewed by Jacqueline Brooks, MBBCH, MRCPsych From the WebMD Archives
March 30, 2001 — People suffering from memory impairment can enhance their quality of life by wearing a pager programmed to transmit reminders of important tasks. In a British study, the personalized text messaging enabled stroke, brain injury, and early-stage Alzheimer’s patients to live more independently, easing the worry of family and caregivers.
The paging system “is very, very flexible and adaptable,” study author Barbara A. Wilson, PhD, tells WebMD. “We’ve used it for one man in a nursing home to teach him where the toilets were, and for an international businessman who needed it for meetings.” Wilson is professor of rehabilitation studies at Addenbrooke’s Hospital and The Oliver Zangwill Centre for Neuropsychological Rehabilitation in England.
All 143 study volunteers, aged 8-83, who participated in the study had problems with memory, planning, concentration, or organization due to a variety of causes. A few had progressive disorders like Alzheimer’s, but the majority had conditions that do not worsen over time, like head injury.
Each person learned how to use the pager properly, and then, with the help of a family member or caregiver, chose several individually tailored task prompts. For example, one asked to receive a message each morning telling her the day and date, and another requested a message each night reminding him to lock his front door. Others were instructed to take medications, others to feed their pets.
More than 80% of the volunteers were more successful at remembering to execute their tasks with the aid of the pager than without. On average, pager users performed their target activities nearly 75% of the time, while those without a pager remembered less than 50% of the time. The findings are published in the April issue of the Journal of Neurology, Neurosurgery, and Psychiatry.
It’s especially important to note that in many subjects, the improvements lingered even after the pagers were returned, says David Olson, MD, a staff neurologist at Georgia Regional Hospital in Atlanta. According to Olson, who reviewed the research for WebMD, this means that “people can still learn despite the fact that they’ve had brain injury.”
It’s “a matter of establishing routine,” Wilson says. Rather than restoring the patient’s memory, the pager is reinforcing desired behaviors, whether taking medication or feeding the dog, until it “becomes habit.”
The system is best suited to patients with head injury, stroke, brain infection, poor oxygen supply to the brain, or brain tumor, who also have problems with day-to-day memory, Wilson says. “They have to be able to read, and they have to want to do at least some things independently. For the vast majority of patients of this type, it’s very successful.”
People who have difficulty executing tasks are at a disadvantage.
“If it’s a pure memory deficit, they learn during the pager phase, but if they have executive problems, [like problems planning things,] they don’t learn as well. They need the pager much longer,” Wilson tells WebMD.
Only three subjects in the study had Alzheimer’s disease, and there was not enough information from the study to predict what will happen as their illness progresses, Wilson says. But based on this work, the pager likely would become less effective as the patient loses memory for how, and not just when, to perform a task.
“It’s not a solution for everybody,” agrees Duane Davis, president of SHPS eCare Technologies in Atlanta, a company producing Internet-based patient paging systems. “It wouldn’t work for those with severe [thinking] difficulties who really need constant care. But if an individual can self-initiate, act on a prompt, this type of technology can allow them much more autonomy. It can turn lives around, enabling someone to keep a job, improving confidence. It can also comfort the caregivers,” he tells WebMD. Davis was not involved in the study.
The study is not perfect, Olson says, and one problem, he points out, is that there is no information about how these people did in the longer term. Nonetheless, “this is an innovative way of using a simple technology to [bring about] improved outcomes for people with brain injury,” he tells WebMD.
Another expert concurs.
“It is not completely clear from the data presented that this system has the potential to render someone requiring a caregiver independent,” says Richard J. Caselli, MD, associate professor of neurology at The Mayo Clinic in Scottsdale, Ariz. It is, however, “a clever approach to a common [thinking] disorder,” and worthy of further investigation. Caselli also reviewed the work for WebMD.
