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23 August 2010, Delft, Netherlands
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Prof Maurice Mulvenna, University of Ulster
1
Designing and Evaluating a Cognitive Prosthetic for People with Mild Dementia
COGKNOW Consortium Sep 2006 - Aug 2009
11 organisations in 8 countries
Aims To develop and evaluate a user-validated
remotely configurable cognitive prosthetic device with associated services for people with mild dementia
To help people to experience greater
autonomy and feelings of empowerment, and to enjoy an enhanced quality of life
To get knowledge and better understand the
actual use of cognitive assistive devices To identify important factors for consideration
in the process of delivering assistive devices to persons with cognitive impairment caused by dementia
Dementia
A progressive, chronic disease • 5% of all persons above 65
• over 40% of people above 90
About 1.9 million elderly people in Europe
experience mild dementia, the target group of COGKNOW.
In 2050 this figure will be doubled
to 3.8 million due to the ageing population.
Most experience unmet needs: memory, social contact, daily life activities, feelings of anxiety
COGKNOW Focus 4 Need areas that are most frequently unmet
Remembering Maintain social contacts
Perform daily activities Enhance feelings of
safety
Workshops with PwD’s & carers (15 dyads)
Technical Development Field test #1 and Evaluation
Equally
Equally
Results from Field test #2 are input for 3rd stage of Technical development
User centered approach • . Users: 45 people with dementia
(GDS 3-5/MMSE 17-25)
45 informal carers ± 12 professional carers • Needs inventory workshops and
individual interviews • . Functional requirements list • . Technical development • . Field testing prototype • Evaluation • . Updating requirements
Developmental design
Results from Field test #1 are input for 2nd stage of Technical development
2006-2007
2007-2008
2008-2009
Three iterative cycles
Workshops: Participants in year 1
Amsterdam (6) Belfast (6) Luleå (5) Persons with dementia
Age Mean 64.0 (range 56-78)
Mean 72.7 (range 65- 86)
Mean 67.8 (range 60-77)
Gender 3 female 3 male
5 female 1 male
3 female 2 male
Civil status 5 married 1 widow
3 married 2 widowed 1 single
5 married
Carers Age Mean 58.5
(range 49-78) Mean 53.0 (range 40-72)
Mean 61.4 (range 23 – 78)
Gender 4 female 2 male
3 female 3 male
2 female 3 male
Relation to patient
5 spouses 1 daughter
3 spouses 2 children 1 cousin
4 spouses 1 son
Amsterdam Belfast Luleå Support for memory
Reminder for not forgetting activities/ appointments/take medicine/to take things outdoors, like key, mobile phone
Item locator, misplacement of items is a key early, and almost universal, symptom of a dementia
Activity reminder/electronic calendar, stationary device with touch screen
Support for social contacts Picture dialling function on touch screen integrated within the screen of the stationary device of reminding system
Electronic calendar with emphasis on appointments and social activities pending.
Picture dialling function on touch screen integrated within the screen of the stationary device of the reminding system
Support with daily activities Support for activities for pleasure: f.i. picture gramophone ENABLE-project
Pill dispenser – medication management issue identified as an important “daily activity”
Support for activities for pleasure: e.g., picture of TV on touch screen of the stationary device that starts TV when touched
Enhance feelings of safety Support during cooking or Warning to close door/ take things outdoors such as keys or simple mobile phone
Picture telephone identified in workshop discussions
Reminder to turn devices of on stationary device or Direct or easy contact possibilities to a service or emergency line
Workshops: Results
COGKNOW Day Navigator
Reminding function
• Day, time, reminders
Picture dialling
Activity support
• Media control function
• Activity assistance
Safety warnings (door/fridge open and outdoors navigation)
• Users perspective Insight into user needs; evaluate the user-friendliness, usability, usefulness and the impact of the cognitive prosthetic device in the four selected need domains, and on autonomy and quality of life
– Research methods
User workshops and individual field tests at user homes (prescribed tasks, observations, semi-structured interviews, in-situ measurement, inventory of bottle-necks)
• Technical factors perspective
• Business factors perspective
Evaluation strategy
Results User Evaluation COGKNOW Day Navigator V3 Overall • judged as useful by people with dementia and carers,
especially the reminding functionality and picture dialling. The safety function needs to be further developed (in home and outdoor take me home service).
People appreciate the personalisation. General wish for dynamic adaptation of reminders
• some people found it not directly useful for their present situation
• most people with dementia and carers found CDN, user friendly, easy to operate and easy to understand
• Too early to draw firm conclusions on impact on daily life, but users expect the device to be supportive, both for the autonomy and quality of life of people with dementia and the burden of carers
• Approach adopted was to utilise off-the-shelf technology and develop a suite of personalised software services.
• Technical development was iterative and driven by three cycles
of user need assessment and evaluation • Technological development focused on advancing state-of-the-
art in the following areas: • multi-modal interfaces • context awareness • systems integration • data storage and
exchange
Network
Door Sensor
CogKnow Sensorised Home
GPS
CogKnow Web Interface
CogKnow Home Hub
CogKnow Cognitive Assistant
FridgeSensor
CogKnow Server
GPRSPatient
Carer
Technical factors perspective
Technical evaluation • Overall functional system produced which reflected the views
of both: – User perceived needs – Adaptation following usage of the system
• Final solution was technically complex and it was challenging to hide this from both people with dementia and carers.
• Clear benefits from avoiding new device/hardware development and focusing on personalised suite of services.
• The above have identified further areas for consideration: – Improved means of remote support required. – Assessment of usability over longer periods of time. – Scalability issues surrounding large scale deployments.
Business perspective
Internal workshop
Country Workshops
OpportunityWorkshop Trial 2 Trial 3
April 08 Summer 08 Fall 08 Spring 09 June09
Market factors • Target group
• Context of use
• Value proposition
Business factors • Business roles
• Actors
• Scenarios
Partnerships • Customer reach
• Value network
• Profit Potential
Aim: To check the viability of COGKNOW business opportunities, and identify critical business success factors
Business evaluation Some country workshop findings: Value proposition for care provider • increased care quality and
capacity • cost reduction • economies of scale and scope
through more integrated systems
Potential benefits for people with dementia:
• continued independence • feelings of autonomy • increased activity ability • increased self-esteem • enhanced quality of life
Potential Carer benefits • peace-of-mind when not present • decrease of burden
Opportunity workshop findings: Critical issues Customer reach • acceptance of ICT • raising sufficient awareness
Value network • create viable partnerships in the
field of care, welfare and comfort
Profit Potential • Capture sufficient users from
potential target group • Define a viable business scenario
– COGKNOW services positioned as comfort services
vs – COGKNOW services positioned as
care services
Recommendations
• Further technical development (e.g. stability, open standards, improved means of remote support)
• Field testing with users on a larger scale and for a longer time
period • Investigation of scalability issues surrounding large scale
deployments • Designing a viable business model
