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Neuroaugmentation & Cognitive Wearables Survey (for Providers)

Instructions

This survey is designed for caregivers, healthcare providers, and professionals who support individuals with cognitive challenges.

It contains 6 (six) sections and should take about 10-15 minutes to complete.

Please answer based on your observations and experiences working with your patient population. Required questions are marked with an asterisk (*).

Geographic Region

Section 1: Cognitive Profile of Your Patients

Patient Population What cognitive conditions do you primarily work with? (Select all that apply)

Other (condition not listed)

What is your relationship to those with cognitive challenges?

Neurologist

Family caregiver

Family Physician

Professional caregiver

Nurse

Therapist (OT/PT/Speech

Neuropsychologist

Other healthcare professional

Condition Information

Observed Cognitive Challenges Based on your observations, rank the cognitive challenges that most impact your patients/care recipients (1 = most impactful):

Attention/focus difficulties

Memory impairment

Executive function deficits

Language/communication issues

Spatial/navigational difficulties

Emotional regulation

Processing speed

Functional Impact Which daily activities are most affected by cognitive challenges? (Select top 3)

Medication management

Appointment keeping

Personal hygiene/self-care

Meal preparation

Social interaction

Safety/avoiding hazards

Independent navigation

Financial management

Other:

Current Support Strategies Which strategies do you currently use to support cognitive function? (Select all that apply)

Written reminders/notes

Digital calendars/alarms

Visual cues in environment

Verbal prompting

Structured routines

Medication management

Direct assistance

Personal Experience What is the most effective strategy you've found for your patients?

Unaddressed Need What cognitive support need remains most unaddressed?

Section 2: Technology Experience and Attitude

Current Technology Use

Which assistive technologies do your patients/care recipients currently use? (Select all that apply)

Smartphone reminder apps

GPS tracking devices

Smart home technology

Medication management systems

Wearable devices

None

Other:

What barriers have you observed to technology adoption? (Select top 3)

Other:

Do your patients/care recipients typically wear glasses?

Most wear glasses full-time

Some wear glasses full-time

Most wear glasses part-time

Few wear glasses

What challenges have you observed with patients/care recipients wearing glasses?

Forgetting to wear them

Losing them

Discomfort/fit issues

Resistance to wearing them

Difficulty keeping them clean

None

Would smart glasses be acceptable to your patients/care recipients?

Yes, most would accept them

Yes, some would accept them

Maybe, with proper introduction

No, most would resist them

Technology Attitudes Based on your experience, how do you feel about the following statements?

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Most patients would accept head-worn technology
Automated systems would reduce caregiver burden
Privacy concerns outweigh potential benefits
The appearance of devices is critical for adoption
Technology training is a significant barrier