Assistive Technology for Promoting Physical and Mental Exercise to Delay Progression of Cognitive Degeneration in Patients with Dementia

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Assistive Technology for Promoting Physical and
Mental Exercise to Delay Progression of Cognitive
Degeneration in Patients with Dementia
SIBHI 2007
Advisors Dr. Debnath Dr. Riley-Doucet

• Presented by
• Ken Early
• Naveen Chilukoti
• Sarvinder Sandhu

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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
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Background Continued

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

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

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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

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A Distorted Perception
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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

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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 patients quality of life and care

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Requirements and Considerations for Design

• Usability and Interfacing
• Adaptability
• Portability
• Reliability
• Price
• Safety

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Our Research

• Exercise Physiology
• Cycling and Ergometry
• Visual Priming
• Cues
• Multi Stimulatory Effects
• Lights

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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.
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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).

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Lights - Relax Heart Rate Decreases

• Calming Colors
• Pink
• Peach
• Beige
• Ivory
• Light blues
• Greens
• Lavenders

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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
cant race fast enough. Its a tranquilizing
color that saps health and energy vitality your
energy. Even the color-blind are tranquilized by
pink rooms."
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?
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Do you feel more relaxed? ?
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Targets of the Game

• Cognitive stimulation
• Memory
• Matching
• Problem solving
• Judgment
• Recollection

Goal of the game Subdue cognitive deterioration

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Human Machine Interfacing

• Graphical User Interface (GUI)
• XNA Game Studio/C
• Input device
• Microcontroller (Buttons, Bike Pedal)
• Output device
• Monitor, Speakers

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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
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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
D
C
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Problem With Cycling in Game

• Inability of patient to cycle for extended period
  of time

How do we fix this?
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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).

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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

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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
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Hall Effect Sensor

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

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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
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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 Qs As and place
  them in arrays
• Example What year is it? 2004200520062007
  D,What is 23? 3456C,
• Windows Forms compares microcontroller output to
  correct answer and responds accordingly

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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

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To Date
Use technology to assist dementia
patients Integrated cognitive and physical
exercise into an assistive technology system
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Monetary DemandsPlease ?

• 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

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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

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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)651010-1013
• 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)

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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), 563571.
• 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.

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Questions?