Assisted Cognition in Community, Employment and Support Settings

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SPRING 2004 VOL. 15, #2

Project ACCESS: Developing technology tools to assist people who have cognitive disabilities

In our high-tech society, devices that once were relegated to the realm of science fiction are becoming commonplace and affordable. We talk on mobile phones that do double or triple duty as digital cameras and keepers of our calendars and address books. We drive cars that monitor how our vehicle is performing and call for assistance if we’re in trouble. We hike in the mountains and navigate on the water with global positioning system (GPS) devices that use satellite signals to help keep us on track and off the rocks.

Researchers are now beginning to adapt and enhance these everyday labor- and sometimes life-saving devices, with the goal of allowing some people with significant cognitive disabilities to live with increased independence, as well as relieve their caregivers and family members of some of the burdens of care.

At the University of Washington, investigators from the Center for Technology and Disability Studies (CTDS), a component of the Center on Human Development and Disability and the Department of Rehabilitation Medicine, are collaborating on a research project with scientists from the Department of Computer Science and Engineering (CSE), who have prototype devices already under development. Project ACCESS (Assisted Cognition in Community, Employment and Support Settings) was recently funded by the National Institute on Disability and Rehabilitation Research.

“We’re very excited about this as an interdisciplinary project,” said principal investigator Kurt Johnson, Ph.D., associate professor of rehabilitation medicine and director of CTDS. “We have been talking about assisted cognition for people with developmental disabilities and brain injuries for some time. As the field of artificial intelligence has matured, there is increasing potential that ‘intelligent’ devices might be created that could provide assisted cognition without the direct supervision of a caregiver or personal assistant.”

Investigators from CSE include coprincipal investigator Henry Kautz, Ph.D., and Gaetano Borriello, Ph.D. Investigators from CTDS are Mark Harniss, Ph.D., Pat Brown, Ed.D., and Brian Dudgeon, Ph.D.

CSE investigators are working on two devices. The Activity Compass, which exists as a proof-of-concept prototype, meshes several technologies: a Palm Pilot, a GPS receiver and a wireless modem. Over time, it will learn a user’s typical daily routines and monitor for variations, and then decide whether a prompt is needed if the routine is unexpectedly changed.

The ADL Prompter, which currently exists as a concept and set of supporting designs and algorithms, will monitor data collected by sensors embedded in a living or work environment and use artificial intelligence to interpret data from the sensors and make decisions based on the user’s needs.

The CSE investigators’ initial focus was on patients with Alzheimer’s disease. However, using Alzheimer’s patients as research participants can be difficult, since their cognitive function is constantly changing. The idea of collaborating on a grant came when Harniss began attending Kautz’s seminars, and realized CSE’s prototype devices could be of value to clients with intellectual disabilities who are served by CHDD’s Employment Training Program, while the ETP clients could participate productively in the research. “They tend to have very stable and consistent cognitive function, and will make good research participants as we develop and refine prototypes,” said Harniss.

In subsequent years, the researchers will utilize two additional groups in developing the devices: people with multiple sclerosis and people with traumatic brain injury. “In the first part of our research, we’re gathering information about potential devices and what would best aid our clients,” said Brown, who heads the Employment Training program. “We think a device that would help with navigation, that would make it easier to travel by bus to and from work and community activities, would make sense.”

For example, said Harniss, a device like the Activity Compass, combining GPS and cellular telephone technology, could assist individuals with moving around in the community and could communicate with the public bus system. “Every Metro bus in Seattle/King County has a GPS connection. The device might tell the user, ‘The #72 bus is coming. You should get on it to get to your job.’ The device would prompt the individual and, ideally, contact the caregiver if there were problems. It would also have the capacity to gather information about the person’s location and direction of travel and, based on that information, give a different set of prompts. It would potentially be able to learn the individual’s common navigation patterns but allow for some flexibility: it should be able to support the user who goes to novel places as well.”

Such technology might enable the individual to take a regular bus to work, rather than relying on a special bus or van service, said Brown. “With such a device, caregivers could feel confident that the people they care for are okay. It has the potential to foster more independence and allow people to experience the community without always needing someone to accompany them.”

Another device might provide memory prompts. “This is definitely an issue for many people with intellectual disabilities and traumatic brain injury,” said Brown. “The idea would be a device that provides social cueing without being obtrusive. For example at work, the prompt might say ‘it’s time to take a break with everyone else,’ or ‘you’ve been on break for 15 minutes’—the same reminders that coworkers or a job coach might give, but less obtrusively, and promoting independence.”

The ADL Prompter could involve placing sensors throughout the home to monitor and help someone live safely and independently, said Harniss. “Did the individual get up? Did he open the cupboard and get his breakfast cereal? Is the stove on or off? Did she take her medication or at least open the pill bottle? There are many daily-living prompts that would be useful for a range of people.”

Such devices would provide more independence, said Harniss, at the same time maintaining some security and protection, while reducing the efforts of caregivers. “That’s a big concern. Families end up doing a lot of the work, and there is a lot of burnout. However, there are also privacy issues for the individual with disabilities, because you’re monitoring someone who may not want to be monitored, or even understand it. There must be controls and safeguards to ensure people’s right to privacy, which in a sense is being taken away by technology intended to provide more independence.”

As Computer Science and Engineering researchers move forward on developing devices involving artificial intelligence and ubiquitous computing, Harniss and Brown will interview selected ETP clients and caregivers about their current transportation patterns and needs. “We’ll start with people who use Metro’s ACCESS buses or other transportation, analyze their responses, and provide this information to the computer science people who will use it in development of tools,” said Harniss. “

At the same time, we’ll be thinking about how to design a device that provides adequate information and yet is simple to use. It will have to involve universal design, since many individuals have sensory or mobility disabilities in addition to cognitive disabilities. It should also work for a broad range of individuals in addition to people who are cognitively impaired—for example, people who are blind or visually impaired.

“The device will initially be field-Henry Kautz watches as a graduate student programs the prototype Activity Compass with data on Metro bus routes. UW photo by Mary Levin tested by students without cognitive disabilities, and then by individuals with cognitive disabilities, probably working along with their job coaches,” said Brown. “Then we hope the job coach will be able to fade away, and it will be a fully functioning device that they will be able to use with monitoring by the caregiver.”

The researchers note that development of assisted cognition is in its infancy, and it will be many years before such devices are on the market. “The outcome of our work will be the continued development of prototype devices that provide sophisticated assistance in functional areas requiring cognitive skills, as well as the training protocols needed to prepare individuals to use them,” said Harniss. “It is likely that within 10 years, assisted cognition systems will enable individuals with significant cognitive disabilities to experience greater independence in employment and community activities, without sacrificing personal safety or appropriate levels of support.”

More information on Project ACCESS is on the web at cognitivetech.washington.edu.

Reprinted from CHDD OUTLOOK , published by the Center on Human Development and Disability (CHDD) at the University of Washington Health Sciences Center. An electronic version is at http://depts.washington.edu/chdd/OUTLOOK/ OUTLOOK.html chdd@u.washington.edu http://depts.washington.edu/chdd/ Writer and editor: Laurie McHale