Cognitive Technology applications as domestic support for elderly people: The PST projects experience

1. Cognitive Technology applications as domestic support for elderly people:The PST projects experience Lorenza Tiberio ISTC-CNR [PST] Institute for Cognitive Science and Technology National Research Council of Italy Planning and Scheduling Team http://pst.istc.cnr.it Workshop on Telematics and Robotics for the Quality of Life of the Elderly – ISTC-CNR – Rome 28 September 2009

2. Outline • Introduction & Rationale • LiteratureReview • Cognitive decline in aging • Memory Training Intervention • AssistiveTechnologyforCognition (ATC) • About PST ProjectsExperience • RoboCare • The system Design • UserEvaluation • OutcomesofRoboCareEvaluation • CogGym • Project Motivation • Architecture • CurrentImplementation and future work • Conclusions

3. Elderlypopulationincrease! Mobilityand cognitive impairments lead to functional decline, thereby reducing independence Introduction Active lifestyle • Can physical activity and cognitive training intervention • prevent or delay the onset of age-related cognitive impairment? • (Verhaeghen et. al., 1992; Floyd & Scogin, 1997; Willis et al., 2006; Craick et al., 2007, Rockwood& Middleton, 2007) • Can technology contribute to improve cognitive function in • older adults? (Basaket al., 2008; Kirsch et al., 2004)

4. Cognitive decline in aging LiteratureReview Acquired knowledge Basicbiologicalcapacitytolearn Performance Crystallized Intelligence • NORMAL AGING • Natural decline in bodily function • Declineoffluid intelligence but • maintenance of crystallized • intelligence. • PATHOLOGICAL AGING • Organic brain disorder • Severe irreversible cognitive • decline Fluid Intelligence Young Adulthood Middle Adulthood Late Adulthood Infancy Childhood

5. Memory Training Literature LiteratureReview • Cognitive trainingmay have substantial and lasting effects on the cognitive abilities of older adults(e.g. Ball et all., 2002; Wolinsky et al.2006; Park et all., 2007). • Recent researches indicate that regularly scheduled cognitive exercisescan not only improve cognitive functioning, but also reduce the risk of dementia(Wilson et all., 2002). • Traditional training usually consist in simple exercises “paper and pencil”orcomputerized-basedincluding different tasks (e.g reasoning, recognition, perception, speed of information processing, attention and memory)

6. Computer training programs LiteratureReview • Brain Age (Nintendo Japan) • Brain Fitness (Posit Science, CA) • Happy Neuron (Quixit, France) • Mindfit (Cognitive Fit, Israel) • Lumonosity (Stanford University) Computer training programs may improve specific skills generically involved with games But there is a little evidence yetthat “playing computer games” improves other skills or reduce the risk of memory loss

7. Technologycontributetomentalhealth LiteratureReview AssistiveTechnologyforCognition (ATC) Compensative or training technological devices that support and stimulate cognitive functions, in order to improve or maintainfunctionalabilities in dailyactivities(LoPrestiet al., 2004; Schereret al., 2005). • ATC interventions can represent an innovative support in case of : • Cognitive Impairment & Dementia • Traumatic Brain injury • Cerebrovascular injury • Autism • Learningdisabilities

8. ATC in Eldercare LiteratureReview “A cognitive orthotic system intended to help older adults adapt to cognitive decline and continue the satisfactory performance of routine activities. Autominder achieves this goal by providing adaptive, personalized reminders of (basic, instrumental, and extended) activities of daily living”. (Pollack et al., 2003) PEAT (Planning and Execution Assistant and Trainer) is an hand-held device increasing the independence of persons with brain injury by compensation for executive function deficits. (Levinson R., 1997) COACH supports older adults with moderate-levels of dementia and their caregivers by audio and/or audio-video prompts. (Mihailidis et al. 2008)

9. What do elderly people thinkabout ATC? Whendealingwithtechnological applications the acceptability by elderly users is a relevant issue. LiteratureReview Demiriset al., 2008 • Privacy violation; • Lack of human responders or a • replacement of human assistance • by technology; • User-friendliness of the devices; • Need for training tailored to elderly. • People overestimatemanipulative • and underestimate cognitive abilities; • People prefer small robots, hardly • resemblinghumanbeings; • Robots should intrude as little as • possible in domestic life; • Robots should simply respond to • the task to be performed. Scopellitiet al., 2005

10. RoboCareDomesticEnvironment PST Projects Experience “The objectiveof the project istobuild a distributedmulti-agent systemwhichprovidesassistanceservicesforelderlyusers at home. The agents are a highlyheterogeneouscollectionoffixed and mobile robotic, sensoryandproblemsolvingcomponents. The project iscentered on obtaining a virtualcommunityofhuman and artificialagentswhocooperate in the continuous management ofanenclosedenvironment.” Quote from the original project proposal (2001)

11. RoboCare: Userevaluation PST Projects Experience Aimof the study Undestandingusers’ attitudesand psychological variables affecting acceptability of cognitive support system in domestic environment: • Likelihood of the proposed scenarios • Utility and acceptability of the system • Users’ preferences with respect to proactive and on-demand • interaction • Influence of psychological variables on acceptability and • usefulness

12. RDE: Userevaluation PST Projects Experience Method Participants 100 elderly (average age of 70 years) recruited through the support of an university for the elderly in Rome and a snowball sampling procedure. Materials Eight short movies (< 2 minutes each) showing potential interaction scenarios between an elderly person and the robotic agent in a real domestic environment.

13. Scenarios' Description

14. RDE: Userevaluation PST Projects Experience Method Tools Questionnaire dividedinto 3 sections, plus socio-demograpichsfocused on: likelihood of the situations presented, usefulness and acceptability of the system; user’s attitude towards intelligent system; emotional reaction to possible implementation of the system in user’s home. Likert Scale • Procedure • Participants were shown the eight videos: • on a notebook monitor in a face-to-face administration • on a larger screen in a small-group administration

15. OutcomesofRoboCareEvaluation PST Projects Experience Likelihood Usefulness

16. OutcomesofRoboCareEvaluation PST Projects Experience Acceptability A signicantcorrelationemerged(Pearson's r) between likelihood of a specic scenario, usefulness and acceptability of the system in that scenario. (i.e., the higher the likelihood of the scenario, the higher the users‘ perceived usefulness and the probability they would accept such a device at home).

17. OutcomesofRoboCareEvaluation PST Projects Experience Interactivesituations: User-initiative vs. System-initiative System- initiative and User-initiativesituations involving emergency and healthcare (safety) were evaluated as significantly more likely, more useful and more acceptable than System-initiative situations referring to suggestions.

18. OutcomesofRoboCareEvaluation PST Projects Experience Influenceofpsychologicalaspects. • Perceived health was not found tosignificantlyinfluence the • attitudetowards the cognitive system. • Worry about future cognitive impairment have an effect on user’s • attitude. Doesage-relatedmemory loss worryyou?

19. OutcomesofRoboCareEvaluation PST Projects Experience Influenceofpsychologicalaspects. “Wouldyoulike the support system tokeepyourmemoryactivethroughgames/exercises?” People reporting a higher level of worry expressed a better evaluation of Advantages and capabilities of the cognitive system support (possibility for the system to perform tasks at home, support the users' activities and reduce age-related impairments).

20. Whattheseresultssuggest? PST Projects Experience • A well defined relationship between likelihood of situations, perceived utility of and acceptability for the cognitive system support (emergency situation vs. uncritical activities in everyday life) • The distinction between User-initiative vs. System-Initiative situations showed to be meaningful as well, because elderly people evaluations of the system are influenced by the specific typology of the activity in which assistance is given. Key role of safety in elderly people’s experience Important vs.unimportant activities

21. Whattheseresultssuggest? PST Projects Experience • Elderly persons showing a great apprehension for age-related cognitive impairments perceived an higher utility and acceptability of the system in terms of a cognitive resource for daily activities demanding use of memory. Possibility to interact with the system through an active training to enhance their cognitive functioning. Can technology contribute to the support and stimulation of older adults’ mental abilities?

22. CogGym: Domestic Cognitive Gym PST Projects Experience Motivation Empirical evidences outline that cognitive stimulation had a significant positive impact as well for maintaining a high-quality cognitive performance. The CogGym Idea • The CogGym Framework is intended to exploit Assistive Technology for Cognition (ATC) by providing immediate access to training services in an ecological context in order to reinforce elderly declining cognitive resources • The framework integrates a number of techniques from constraint based problem solving techniques to cognitive systems research (e.g., for the user related issues) Aging is responsible for a progressive decline of cognitive functions.

23. Case Studydrivendevelopment PST Projects Experience • Case-study driven development: each case is a known instance of age • related cognitive decline • Problem solvingthe ability to solve new, non-routine problems, e.g., using new technology • Spatial orientationthe ability to locate places and objects, orientation in geographical space and path planning (e.g., finding shortcuts) • Prospective memorythe ability to manage tasks which are planned to occur in the future

24. How does CogGym train Prospective Memory? PST Projects Experience • Smart blackboardmaintains a list of grocery items • the blackboard is both written by the assisted person and read by the system • the system can propose a cognitive exercise pertaining the list of shopping items • the system may be aware of missing items before the user notices (e.g., through RFIDs), and stimulate the useraccordingly

25. How does CogGym train Prospective Memory? PST Projects Experience Traditional cognitive training exercise Memorization of generic grocery items or actions to be performed, carried out with pen and paper Traditional AAL technology Compensatory support (e.g., reminding), or not contextualized training COGGYM Training • Related to real aspects of the user needs (i.e., the need to prepare the shopping list); • Difficulty and frequency are decided on the basis of previous users performances. Contextualizing and personalizing the exercises enhances the training efficacy and increases the probability that the memorization strategies are employed in real-life situations

26. The CogGymArchitecture PST Projects Experience TRAINING KNOWLEDGE REPOSITORY User status assessment Environmental assessment USER MODELER PROBLEM SOLVER SCENARIO MODELER DATA FILTERING INTERACTION MANAGER DATA FILTERING PERFORMANCE DATA BASE ENVIRONMENTAL SENSORS

27. Current and future work PST Projects Experience • Improvingofprospectivememory case: • We are addingdifferenttypesofexercises • We are studingwheter alternative modalitieswouldbe more suitableforelderly people • Testing the software framework on additionalcases • Weplanto include the spatialorientation and problemsolving case • Weplantoadopt the experimentalmethodologywehavedevelopedfromRoboCare • Participatory Design and development process together with users (older people, caregivers, gerontologist, computer scientists)

28. Conclusoins • We have presented an overview of recent and current efforts in • synthesizing cognitive technology for elderly population • integrating heterogeneous AI technologies to obtain innovative interactive systems • understanding critical features for user’s involvement and acceptance • A multi-disciplinary team of people • RoboCare and CogGym generate from an hybridization of teams that used to work in parallel • The obtained flavor is quite unique • Even if … a non trivial effort to understand each other is always required.