A tablet computer-assisted motor and language skills training programme to promote communication development in children with autism: development and pilot study

Autism is a heterogenous condition, encompassing many different subtypes and presentations. Of those people with autism who lack communicative speech, some are more skilled at receptive language than their expressive difficulty might suggest. This disparity between what can be spoken and what can be understood correlates with motor and especially oral motor abilities, and thus may be a consequence of limits to oral motor skill. Point OutWords, tablet-based software targeted for this subgroup, builds on autistic perceptual and cognitive strengths to develop manual motor and oral motor skills prerequisite to communication by pointing or speaking. Although typical implementations of user-centred design rely on communicative speech, Point OutWords users were involved as co-creators both directly via their own nonverbal behavioural choices and indirectly via their communication therapists’ reports; resulting features include vectorised, high-contrast graphics, exogenous cues to help capture and maintain attention, customisable reinforcement prompts, and accommodation of open-loop visuomotor control

Applying Mobile Application Development to Help Dementia and Alzheimer Patients

Caregiver anecdotes attest that music and photographs play an important role for family members diagnosed with Alzheimer’s disease (AD), even those with severe AD. Tablets and iPads, which are prevalent, can be utilized with dementia patients in portraying favorite music and family photographs via apps developed in close partnership with geriatric facilities. This study addresses cognitive functioning and quality of life for people diagnosed with dementia via technology. Research has shown that technology instruments such as iPods, help stimulate those with dementia. This study focuses on innovative devices such as iPads and tablets, which are mainstream and easy to use, cannot only help determine stage of dementia, but also provide stimulation to improve cognitive functioning. It is hoped that this research will analyze that specially created apps and existing assistive software can be used to decrease the symptoms and improve cognition of older adults suffering from AD or other dementia related diseases. Via service-learning courses, students developed an easy-to-use application for tablets to help older adults with disabilities more readily use the technology. This research will discuss student developed mobile applications in the scope of helping improve the quality of life of patients with AD or dementia

Development of an application for diagnosis, monitoring and rehabilitation of neurodegenerative diseases

The progress of healthcare over the last years led to an aging of the world population, increasing the prevalence of age-related diseases in the society, mainly neurodegenerative diseases. These pathologies currently affect more than 30 million people worldwide, and there is currently no cure for them. The high costs experienced by patients and their families are largely due to the individual monitoring performed by technicians. New technologies are providing alternatives for monitoring, diagnosis and rehabilitation of individuals with these diseases. This project includes the development of a web application which allows patients with neurodegenerative diseases to be monitored with less invasion and costs, enabling greater adherence. The application follows several examples from the literature for the construction of games, includes diagnostic assessments used in the medical field and promotes its use through gamification techniques. The construction of the web server used the Python language and the Flask framework because of the availability of useful modules, large supporting community and scalability. The software was specially designed for people with Parkinson’s disease, featuring a simple navigation between menus and an easy-to-use interface. The web application was named "Mentalist". The development of the application was followed by professional neurologists and the results obtained were guided by clinicians’ practice. According to these experts, the developed functionalities cover the most important aspects of diagnosis, monitoring and rehabilitation, making it a tool of high importance and applicability in daily clinical practiceA melhoria das condições de vida e dos cuidados de saúde nos últimos anos tem originado um envelhecimento da população mundial, aumentando a prevalência de doenças relacionadas com a idade. Neste grupo de doenças destacam-se as doenças neurodegenerativas, que afetam mais de 30 milhões de pessoas e não têm, atualmente, cura. Os elevados custos experienciados pelos pacientes e pelas suas famílias devem-se, em grande parte, ao acompanhamento individual realizado por técnicos. Novas tecnologias têm possibilitado alternativas para o acompanhamento, diagnóstico e reabilitação de indivíduos com estas doenças. Este projeto inclui o desenvolvimento de uma aplicação web que permite a monitorização de pacientes com menos invasão e custos, proporcionando uma maior adesão. A aplicação segue exemplos da literatura para a construção dos jogos, inclui questionários de diagnóstico utilizados no ramo médico e promove a sua utilização através de técnicas de gamificação. Foi utilizada a linguagem Python e o framework Flask para a construção do servidor devido à existência de módulos úteis, grande comunidade de desenvolvedores e escalabilidade. O software foi desenvolvido especialmente para pacientes com a doença de Parkinson, apresentando uma navegação simples entre menus e uma interface fácil de usar. A aplicação web foi denominada "Mentalist". O desenvolvimento da aplicação foi seguido por neurologistas profissionais e os resultados obtidos foram guiados pela experiência dos clínicos. De acordo com estes especialistas, as funcionalidades desenvolvidas contemplam os principais aspetos relativos ao diagnóstico, monitorização e reabilitação, tornando-a num instrumento de grande importância e aplicabilidade na prática clínica diári

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

Exergames and serious games, based on standard personal computers, mobile devices and gaming consoles or on novel immersive Virtual and Augmented Reality techniques, have become popular in the last few years and are now applied in various research fields, among which cognitive assessment and training of heterogeneous target populations. Moreover, the adoption of Web based solutions together with the integration of Artificial Intelligence and Machine Learning algorithms could bring countless advantages, both for the patients and the clinical personnel, as allowing the early detection of some pathological conditions, improving the efficacy and adherence to rehabilitation processes, through the personalisation of training sessions, and optimizing the allocation of resources by the healthcare system. The current work proposes a systematic survey of existing solutions in the field of cognitive assessment and training. We evaluate the visualization and interaction technologies commonly adopted and the measures taken to fulfil the need of the pathological target populations. Moreover, we analyze how implemented solutions are validated, i.e. The chosen experimental designs, data collection and analysis. Finally, we consider the availability of the applications and raw data to the large community of researchers and medical professionals and the actual application of proposed solutions in the standard clinical practice. Despite the potential of these technologies, research is still at an early stage. Although the recent release of accessible immersive virtual reality headsets and the increasing interest on vision-based techniques for tracking body and hands movements, many studies still rely on non-immersive virtual reality (67.2%), mainly mobile and personal computers, and standard gaming tools for interactions (41.5%). Finally, we highlight that although the interest of research community in this field is increasingly higher, the sharing of dataset (10.6%) and implemented applications (3.8%) should be promoted and the number of healthcare structures which have successfully introduced the new technological approaches in the treatment of their host patients is limited (10.2%)

Predicting cognitive fitness to drive with touchscreen DriveSafe DriveAware

Driving is a highly valued daily living activity easily disrupted by illness, injury, or age-related changes. General practitioners (GPs) are ultimately responsible for determining medical fitness to drive but lack valid and reliable tools. The desktop (original) version of DriveSafe DriveAware (DSDA) is a promising, valid and reliable test but it is not practical for medical practice. The concern of this thesis was the conversion of original DSDA into a touchscreen test of cognitive fitness to drive for GPs and occupational therapists to use in predicting patient driving performance without on-road testing. Because we were transitioning from a test administered and scored by a trained assessor to one where patient touch responses were scored in-app, we needed to develop an automatic data collection and scoring system that reflected the decision that would otherwise have been made by an expert-rater. We tested usability of the system with older adults then examined set scoring parameters to determine if these discriminated at-risk from comparison drivers. Results indicated the system we designed reflected the decisions that would have been made by a trained assessor. Next, we conducted a study to examine the internal validity, reliability, and predictive validity of data gathered with touchscreen DSDA. The criterion measure was outcome of a standardised occupational therapy on-road assessment. Rasch analysis provided evidence that touchscreen DSDA had retained the strong psychometric properties of original DSDA. However, results of a discontinued feasibility study indicated potential barriers to uptake of the test by physicians. Touchscreen DSDA may rather be a tool for occupational therapists to use in driver screening and addressing the community mobility need of their clients. Research indicates no there is no one best tool for screening fitness to drive. However, the thesis findings indicate touchscreen DSDA is one useful tool

Digital support for self-management and meaningful activities of people with mild dementia:Development, implementation and feasibility of a person-centred touch-screen intervention

This thesis reports on the research that was conducted to develop and pilot test a person-centred touchscreen-based program (FindMyApps intervention) that supports people with mild dementia and their informal carers in how to use a tablet and apps for self-management and meaningful activities. The program consists of the FindMyApps training for informal carers in supporting people with mild dementia in using a tablet and the FindMyApps selection tool designed to help people with mild dementia find apps for self-management and meaningful activities that fit their needs, wishes and abilities. The program was developed following the Medical Research Council (MRC) Framework for the design and evaluation of complex interventions and in co-creation with end users. The chapters of this thesis describe the first three phases of this framework i.e.: the preclinical or theoretical phase (0); the modelling phase (I) and the exploratory trial (II). The execution of an RCT (III), and further implementation (IV) in case the intervention proves effective, are beyond the scope of this thesis. In the first phase user needs studies were performed to identify user requirements for desired self-management and meaningful activities and to identify user-requirements related to the use of apps. Eight focus groups were performed in which people with mild cognitive impairment (MCI) or mild dementia (n=13) and informal carers (n=15) participated. We also conducted a literature review to explore which training interventions are most effective for people with mild dementia in (re)learning how to use technologies, including handheld touchscreen devices. An electronic search was conducted in the following databases: PubMed, APA PsycInfo (EBSCO) and CINAHL (EBSCO). In total 16 studies met the inclusion criteria. Our review contributed to the growing amount of promising evidence on the potential impact of Errorless learning training interventions for people with mild to moderate dementia in (re)learning how to use technology. Based on these results we developed the FindMyApps training. In the second phase of the framework we developed a first concept of the FindMyApps selection tool based on identified user requirements. To ensure its usability, the web-based tool was developed using a ‘user-participatory design’ involving the close collaboration of potential users, a development team (researchers, developers and designers) and an expert team (experts in person-centred dementia care and ICT). In three short iterative rounds – so called ‘sprints’ – the users (people with dementia (n=8) and (in)formal carers (n=10)) were invited to test whether the prototypes were in line with their needs, wishes and abilities. This generated important insights into user-interface aspects relating to (i) useful content and (ii) a user-friendly tool design. In the third phase we pilot tested the FindMyApps intervention by means of individual semi-structured interviews and a pilot randomized controlled exploratory trial. Twenty people with mild dementia and informal carer dyads were randomly assigned to the FindMyApps group (n=10), receiving either the FindMyApps training and selection tool, or a control condition (n=10), receiving only a short tablet training. Pre- and post-test measurements at a three month follow-up, consisted of questionnaires and post-test semi-structured interviews. Based on the qualitative results and the effect sizes on the outcomes measured in this study, we consider that the FindMyApps intervention has the potential to positively influence the self-management and engagement in meaningful activities in people with dementia. Future studies with a larger sample should better indicate whether this expectation can be confirmed. The intervention will be further improved and tested in a larger pilot-RCT study and its effectiveness subsequently evaluated in a definite RCT

Information technology for active ageing: A review of theory and practice

Active Ageing aims to foster a physically, mentally and socially active lifestyle as a person ages. It is a complex, multi-faceted problem that involves a variety of different actors, such as policy makers, doctors, care givers, family members, friends and, of course, older adults. This review aims to understand the role of a new actor, which increasingly plays the role of enabler and facilitator, i.e., that of the technology provider. The review specifically focuses on Information Technology (IT), with a particular emphasis on software applications, and on how IT can prevent decline, compensate for lost capabilities, aid care, and enhance existing capabilities. The analysis confirms the crucial role of IT in Active Ageing, shows that Active Ageing requires a multidisciplinary approach, and identifies the need for better integration of hardware, software, the environment and the involved actors

Access to Eye-Gaze Control Technology for Children with Cerebral Palsy

Children with cerebral palsy (CP), whose disability may limit speech production and motor skills, are often considered good candidates for the use of eye-gaze technology to access communication, learning and play. At present, little is known about the skills needed to control this technology, which can make it difficult for clinicians to make decisions, or to manage expectations around progress. This is further complicated by the emergence of “teaching” software packages, claiming to improve basic skills such as cause and effect. Children with CP are known to be at a higher risk of vision disorders, including those related to functional vision – how a child functions in vision related activities. These skills (in particular fixation and gaze switching) are similar to those required to make use of eye-gaze technology, so are likely to impact on children’s performance. This thesis uses typically developing children to provide baseline information and to observe how they respond to tasks which were incrementally lowered in terms of cognitive demand. Over three rounds of experiments a pattern emerged that children aged 32 months were able to use it with only minimal instruction. The impact of teaching on performance was also investigated in this section of the study. A group of children with CP were recruited to investigate the most effective way of assessing functional vision skills in this group, with results indicating behavioural measures were most effective. A final study with children with CP used the activities above to look at the performance of this group on eye-gaze tasks. Results suggested good functional gaze control skills were related to better performance on a novel eye-gaze task. The findings suggest that some children may be at a “developmental advantage” if their functional vision and cognitive skills are more developed

An Ambient Assisted Living platform for supporting aging in place of prefrail and frail older adults: Rationale, HomeAssist plaform, quasiexperimental design, and baseline characteristics

Background: Ambient Assisted Living (AAL) technology is expected as a promising way for prolonging the aging in place. Very few evidence-based results are provided support to its real value, notably for frail older adults who have high risk of autonomy loss and of entering in nursing home. Objective: HomeAssist (HA) is a human-centered AAL platform offering a large set of applications for three main age-related need domains (Activities of Daily Living, Safety and Social participation), relying on a basic set of entities (sensors, actuators...). The HA intervention involves monitoring as well as assistive services to support independent living at home. The primary outcomes measures are related to aging in place in terms of effectiveness (institutionalization and hospitalization rates) and efficiency (everyday functioning indices). Secondary outcomes measures include indices of frailty, cognitive functioning, and psychosocial health of participants and their caregivers. Every 6 months, user experience and attitudes towards HA are also collected in equipped participants. Concomitantly, HA usages are collected. Methods: A study assessing the HA efficacy has been designed and is now conducted with 131 older adults aged 81.9 (±6.0) years (from autonomous to frail) who lived alone. The study design is quasi-experimental with a duration of 12 months optionally extensible to 24 months. It includes equipped participants, matched with non-equipped participants (n= 474). Followup assessments occurred at 0, 12 and 24 months. Results: The expected results are to inform the AAL value for independent living, but also to yield informed analysis on AAL usages and adoption in frail older individuals

Software Usability

This volume delivers a collection of high-quality contributions to help broaden developers’ and non-developers’ minds alike when it comes to considering software usability. It presents novel research and experiences and disseminates new ideas accessible to people who might not be software makers but who are undoubtedly software users