Assistive Technology for Promoting Physical and Mental Exercise to Delay Progression of Cognitive Degeneration in Patients with Dementia :Assistive Technology for Promoting Physical and Mental Exercise to Delay Progression of Cognitive Degeneration in Patients with Dementia Presented by: Ken Early Naveen Chilukoti Sarvinder Sandhu SIBHI 2007 Advisors: Dr. Debnath Dr. Riley-Doucet


Alzheimer Background :Alzheimer Background Cell loss in cerebral cortex Intracellular neurofibrillary tangles develop Loss of cholinergic (Acetylcholine) neurotransmitters Amnesia Then the down hill slide…(This is where we come in!) Women are slightly more effected than men Source: Wikipedia.com


Background Continued… :Background Continued… People who maintain healthy cognitive loads have a lower incidence of dementia Social activity and traditional physical exercise are important


Exercising the Mind :Exercising the Mind “Because of an increasing aging population…” “…the field of cognitive exercise is growing” “…defined cognitive exercise can play a critical role in healthy aging.“ Ben Sawyer


Benefits of Exercise for the Elderly :Benefits of Exercise for the Elderly Independence and overall health Maximizes social contact and enjoyment of life Improves weight control and nutrition Aids in digestion and reduces constipation Promotes relaxation


Benefits of Exercise Continued… :Benefits of Exercise Continued… Increase blood flow throughout the body including the brain Prevents muscular and cognitive atrophy Helps prevents contractures Helps prevent blood clots (emboli) Increases overall quality of life


A Distorted Perception :A Distorted Perception


Benefits of Exercise for the Caregiver :Benefits of Exercise for the Caregiver Increased communication Increased patent physical ability Decreased time spent performing ROM (range of motion) Decrease overall dependence on caregiver Increases caregivers free time


Project Objectives :Project Objectives Use technology to promote physical and mental exercise Create a game geared towards Alzheimer's patients Interface an appropriate game with an appropriate physical workout Improve patient’s quality of life and care


Requirements and Considerations for Design :Requirements and Considerations for Design Usability and Interfacing Adaptability Portability Reliability Price Safety


Our Research :Our Research Exercise Physiology Cycling and Ergometry Visual Priming Cues Multi Stimulatory Effects Lights


Cycling and Ergometry :Cycling and Ergometry Ergometry has a comparable cardiovascular output to swimming Both low impact Both are controlled intensity workouts Repetitive, continuous exercise are encouraged Bike workout = Treadmill workout, Yes! Source: Brookstone Inc.


Visual Priming :Visual Priming Priming is the strategy or process of using props to bring to the fore the different types of intrinsic memory (IM) (Parahoo, 2006) Visual or auditory cues seems to activate the amygdala (Le Doux, 1993).


Lights - Relax : Heart Rate Decreases :Lights - Relax : Heart Rate Decreases Calming Colors… Pink Peach Beige Ivory Light blues Greens Lavenders


Slide 15:Dr. Alexander Schauss, Ph.D., director of the American Institute for Biosocial Research in Tacoma Washington, was the first to report the suppression of angry, antagonistic, and anxiety ridden behavior among prisoners: "Even if a person tries to be angry or aggressive in the presence of pink, he can't. The heart muscles can’t race fast enough. It’s a tranquilizing color that saps [health and energy vitality] your energy. Even the color-blind are tranquilized by pink rooms."


Slide 16:?


Slide 17:Do you feel more relaxed? ?


Targets of the Game :Targets of the Game Cognitive stimulation Memory Matching Problem solving Judgment Recollection Goal of the game Subdue cognitive deterioration


Human Machine Interfacing :Human Machine Interfacing Graphical User Interface (GUI) XNA Game Studio/C# Input device Microcontroller (Buttons, Bike Pedal) Output device Monitor, Speakers


XNA Game Studio :XNA Game Studio Based on Visual C# Express (an object-oriented programming language) Create games in Windows platform and for Xbox 360 Easily incorporate content (3D, 2D, sound, etc.) from content creating sources Free Source: www.gamescoreblog.com


Game Design :Game Design Game pad used to change bicyclers direction A, B, C, D Pushbuttons Pedaling required to move biker to “answer” of question Hall effect sensor detects motion A B C D


Problem With Cycling in Game :Problem With Cycling in Game Inability of patient to cycle for extended period of time How do we fix this?


Solution :Solution No continuous biking required Short durations of exercise in game “Three 10-min sessions per day were as effective as one 30-min session” (DeBusk et. al. p.92 paragraph 8).


Game Design Continued… :Game Design Continued… 3 correctly answered questions result in advancement towards a mountain summit 75 correct answers results in completion of game 250+ questions, randomly displayed


Role of the Microcontroller :Role of the Microcontroller Use of Input/Output ports Four push buttons and a hall effect sensor interpret input signals and make decision accordingly Decision is sent to the computer through a serial port Source: Wytec Inc. Source: Digi-Key Corporation


Hall Effect Sensor :Hall Effect Sensor Transducer that varies its output voltage in response magnetic field density Commonly used to time the speed of wheels and shafts


Programming the Microcontroller :Programming the Microcontroller C language used Designated character for each sensor. Corresponding character sent to the computer depending on active sensor. Serial Port Push Button


Windows Forms :Windows Forms GUI application programming interface included as a part of Microsoft's .NET Framework Created a user interface Windows Form Generates random questions with corresponding answers from text file Used “| delimiter” to divide Q’s & A’s and place them in arrays Example; What year is it?| 2004|2005|2006|2007| D,What is 2+3? |3|4|5|6|C, Windows Forms compares microcontroller output to correct answer and responds accordingly


Device Design (Output) :Device Design (Output) Incorporate bike, microcontroller, and game into one device Involves attaching a monitor to the bike that can move away from the patient Monitor can be raised and lowered The device can be set on the floor or table Very portable


Slide 30:To Date Use technology to assist dementia patients Integrated cognitive and physical exercise into an assistive technology system


Monetary Demands…Please ? :Monetary Demands…Please ? Bike $86.90 Monitor $150.00 Adjustable Arm $225.00 Controller $26.35 Home Depot $23.29 Sensors $20.00 Microcontroller $120.00 USB Serial Cable $30.00 Total: ~ $681.54


Future Work :Future Work Incorporate RPM from bike into game Assess prevention of overexertion (mechanical intervention) Increase game functionality Cues Visual Primers Improve graphical interface Improve portability Computer/Monitor


Bibliography :Bibliography DeBusk R., Ulysses Stenestrand, and Megan Sheehan, eds. Training effects of long versus short bouts of exercise in healthy subjects. Am J Cardiol (1990);65:1010-1013 Dementia. ISCID Encyclopedia of Science and Philosophy. 2007. International Society for Complexity, Information, and Design. Liberty, J. 2005. Programming C#: Building .NET Applications with C# New York: Pocket Books. Miller, B. 1999. Color Matters. http://www.colormatters.com/body_pink.html (accessed May 25, 2007)


Bibliography Continued… :Bibliography Continued… Nitschke B. 2007. Professional XNA Game Programming. San Francisco: Wrox Publishers Parahoo B., Whall A., Colling K. 2006. Expert nurses' use of implicit memory in the care of patients with Alzheimer's disease. Journal of Advanced Nursing 54 (5), 563–571. Skinner, J. 2005. Exercise Testing and Exercises Prescription for Special Cases. Theoretical Basis and Clinical Application, 90-397. Robert H.P., Berr C., Volteau M., Bertogliati C., Benoit M., Sarazin M., Legrain S., and Dubois B., “Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease”, Clinical Neurology and Neurosurgery, Vol. 108, No. 8, pp. 733-736, 2006.


Questions? :Questions?