Ambient assistive technology for people with dementia: An Answer to the epidemiologic transition
Abstract
Over the past decade, several studies have shed light on how the Ambient Assistive Technology (AAT) may increase the life expectancy of older adults experiencing cognitive decline who continue to live in their own homes, as well as improve their autonomy and independence, facilitate their daily activities, and monitor their health status. These technologies can also assist in facilitating social inclusion, helping families, and supporting healthcare organizations (Rashidi & Mihailidis, 2013). One of the most promising applications of AAT for the aging population is provided by assistive robots (Broadbent, Stafford, & MacDonald, 2009; Nejat, Yiyuan, & Nies, 2008). Both older adults with dementia and their caregivers can benefit considerably from the deployment of assistive robots in actual, real-life, contexts of use. However, we still have to fill the gap between the designs of the developers of new technologies and the needs of the users and their caregivers. For example, evaluating what a robot should do and look like, and how it should meet the user’s needs efficiently, and facilitating the work of the caregivers and health professionals so as to prevent technology non-use or abandonment, still remains a challenge, which even the most recent models of user evaluation have not completely solved.
In this chapter, we review the state of the art and possible future developments of AAT for people with dementia, while discussing the main research issues in this area, focusing particularly on assistive service robots for eldercare and assistance services. Current technology design approaches, user-experience evaluation techniques, and assistive technology assessment models are discussed.
... In most AAL research projects, it is assumed that the developed assistive solutions and services will improve the quality of life and well-being of elderly people. Unfortunately, the impact on health and quality of life is not yet firmly documented in the scientific literature (Federici, Tiberio, and Scherer, 2014;Siegel, Hochgatterer, and Dorner, 2014). ...
... Most of the assistive solutions described above were developed and evaluated using a UCD approach and user-experience (UX) evaluation (Borsci, Kurosu, Federici, and Mele, 2013). Over the past decade, the AAL approach strongly promoted the UCD and process in order to meet end users' needs and expectations by adapting products to the characteristics of the physical environment and social milieu in which they are supposed to be used in order to prevent technology nonuse or abandonment (Federici et al., 2014;Scherer, 2014). ...
Heterogeneity in the health status of elderly patients requires a particular care approach and geriatric medicine is the answer. In order to cope with frailty, disability, and diseases, the geriatric assessment approach guides the geriatrician into considering the interaction between functional status and cognitive, medical, affective, environmental, social support, economic, and spirituality dimensions. Rehabilitation is the goal of the geriatric assessment and the introduction of assistive solutions in geriatric rehabilitation makes possible a scenario in which the functioning of elderly people with physical or cognitive limitations is improved. This chapter provides an overview of the areas where technological systems may offer support to the everyday life of the elderly and their caregivers. The contribution of a geriatrician in a Centre for Technical Aid is described, linking the comprehensive geriatric assessment with the ICF model. The lack of implementation of the ICF and the requirement of training in assistive solutions for geriatricians and caregivers are discussed.
... There are many assistive technologies including but not limited to wheelchairs, grab rails, electronic image sensors for students with vision impairments, eye glasses, braille keyboard, eye gaze board, beeping balls in recreational activities and voice recognition software [58,76,[81][82][83][84][85][86]. With the advancement in technology, smart healthcare uses the latest technologies such as big data, deep learning, artificial intelligence, IoT and edge computing, making healthcare solutions more convenient and efficient [87][88][89][90][91]. Smart home and integrated assistive technologies offer e-health services for elderly or handicapped people [47,[92][93][94][95]. Smart real-time healthcare solutions emphasize monitoring of patients using GSM technologies [89,96]. ...
Background:
Despite the rapid proliferation and emphasis on technology, the use of assistive technology among individuals with varying disabilities and age is different. This situation instigates the need for a systematic review to gain a realistic understanding of prominent issues, research trends and assistive technology applications with minimal bias.
Objective:
Identification of leading researchers and prominent publications in assistive technologies. Subsequently, semantic relation between qualitative and quantitative research literature on assistive technologies was explored to future research directions.
Methods:
A manual search across reputed research databases was done to find out relevant literature from January 2005 to April 2020. In this paper, latent semantic analysis (LSA) was done to develop an information model for achieving defined objectives.
Results:
A corpus of 367 research papers published during 2005-2020 was processed using LSA. Term frequency, inverse document frequency of high loading terms provided five major topic solutions. Marcia Scherer, Rory Cooper and Stefano Federici are most noticed authors in assistive technology research. "Smart Assistive Technologies" and "Wearable Technologies for Rehabilitation" came out as contemporary research trends within assistive technologies.
Conclusions:
The manuscript concludes the fact that assistive technologies for rehabilitation are experiencing a transition from standalone mechanical devices towards smart, wearable and connected devices. Implications for Rehabilitation Customized assistive devices could be programmed for multiple uses. User data privacy and internet dependency of smart assistive technologies must be taken care of while designing smart assistive devices for rehabilitation. Fog devices could eliminate the latency issues associated with cloud-based rehabilitation services.
... Acceptability was identified as an assessment factor in 26.7% of the studies [9,22,24,25]. Despite the popularity of the technology acceptance model [35,36], acceptability was measured in a variety of ways (e.g., lack of complaints [25]) or treated as a measure of satisfaction [24]. A total of 53% of the studies used various factors to assess the quality of interaction, such as the overall experience, safety, acceptability, engagement, intention to use, ease of use, helpfulness, enjoyment, and appearance. ...
People with disabilities or special needs can benefit from AI-based conversational agents, which are used in competence training and well-being management. Assessment of the quality of interactions with these chatbots is key to being able to reduce dissatisfaction with them and to understand their potential long-term benefits. This will in turn help to increase adherence to their use, thereby improving the quality of life of the large population of end-users that they are able to serve. We systematically reviewed the literature on methods of assessing the perceived quality of interactions with chatbots, and identified only 15 of 192 papers on this topic that included people with disabilities or special needs in their assessments. The results also highlighted the lack of a shared theoretical framework for assessing the perceived quality of interactions with chatbots. Systematic procedures based on reliable and valid methodologies continue to be needed in this field. The current lack of reliable tools and systematic methods for assessing chatbots for people with disabilities and special needs is concerning, and may lead to unreliable systems entering the market with disruptive consequences for users. Three major conclusions can be drawn from this systematic analysis: (i) researchers should adopt consolidated and comparable methodologies to rule out risks in use; (ii) the constructs of satisfaction and acceptability are different, and should be measured separately; (iii) dedicated tools and methods for assessing the quality of interaction with chatbots should be developed and used to enable the generation of comparable evidence.
... RQ2. Acceptability was mentioned as an assessment factor in 26.7% of the studies [11,25,27,28]. Despite the popularity of the Technology Acceptance Model [37,38], acceptability was assessed in various wayse.g., lack of complaints [28] or as an alternative to satisfaction [27]. A total of 53% of the studies used various factors to assess quality of interaction, such as overall experience, safety, acceptability, engagement, intention to use, ease of use, helpfulness, enjoyment and appearance. ...
Introduction: People with disabilities or special needs can benefit from AI-based conversational agents (i.e., chatbots) that are used for competence training and well-being management. Assessing the quality of interactions with these chatbots is key to being able to reduce dissatisfaction with them and to understanding their potential long-term benefit. This in turn will help to increase adherence to their use, thereby improving the quality of life of the large population of end-users that they are able to serve.
Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we systematically reviewed the literature on methods of assessing the perceived quality of interactions with chatbots using the from Scopus and the Web of Science electronic databases. Using the Boolean operators (AND/OR) the keywords chatbot*, conversational agent*, special needs, disability were combined.
Results: Revealed that only 15 of 192 papers on this topic included people with disabilities or special needs in their assessments. The results also highlighted the lack of a shared theoretical framework for assessing the perceived quality of interactions with chatbots.
Conclusion: Systematic procedures based on reliable and valid methodologies continue to be needed in this field. The current lack of reliable tools and systematic methods to assess chatbots for people with disabilities and special needs is concerning, and ultimately, it may also lead to unreliable systems entering the market with disruptive consequences for people.
• Implications for rehabilitation
• Chatbots applied in rehabilitation are mainly tested in terms of clinical effectiveness and validity with a minimal focus on measuring the quality of the interaction
• The usability and interactive properties of chatbots applied in rehabilitation are not comparable as each tool is measured in different way
• The lack of a common framework to assess chatbots exposes people with disability and special needs to the risk of using unreliable tools
... [2] It is now broadly accepted that they can have a positive impact on the lives of those with a disability. Among others, they improve functioning or help reduce functional decline [3][4][5] and their use has been linked with a better quality of life: they can enhance social participation, [6,7] security and control. [8] Furthermore, they can help reduce institutional costs without significantly increasing household expenses. ...
Purpose: It is widely accepted that social dimensions are crucial when facing a disability. More specifically, a normative incentive to conceal one’s disability, which can lead to abandonment of assistive technology devices (ATD), is often reported. This study seeks to examine this norm.
Method: The expected consequences of having a disability were measured using a sample of 549 able-bodied students from three groups.
Results: The results showed that the expected consequences of having a disability and therefore the descriptive norms associated with disability were less negative for the participants who were familiar with disability, but higher for sports students. Furthermore, the relation between objective and subjective consequences (having a disability and feeling disabled, respectively) and public and private use of ATD were modelled. The model shows that both higher objective and lower subjective consequences were linked to higher ATD use in public and, indirectly, in private.
Conclusion: The present study contributes to the literature on the normative elements related to the use of ATD. Indeed, it shows that when a person makes his/her disability a part of him/herself, she/he is expected to hide it and therefore to avoid using ATD. However, this assessment proves to be context-dependent and calls for the implementation of handicap awareness programs.
• Implications for Rehabilitation
•If faced with a disability, expecting to feel disabled and expecting lower objective consequences are linked to lower ATD use.
•Expected ATD use in private seems to be related to ATD use in public but not to the expected consequences of the disability.
•Expectations and therefore social norms about having a disability are highly context-dependent which encourages the implementation of handicap awareness programs.
... E noto, infatti, che certi deficit cognitivi possono impedire o ostacolare alcuni interventi riabilitativi. La conoscenza dello stato mentale del paziente, inoltre, e un'informazione essenziale per definire un progetto d'intervento che si avvalga anche dell'ausilio di tecnologie assistive e di ambienti forniti di tecnologie avanzate (Federici et al., 2014;Pigliautile et al., 2012;Scherer et al., 2012). ...
La valutazione cognitiva appare una componente fondamentale della valutazione geriatrica multidimensionale e definire delle linee guida su come debba essere condotta sembra un’importante sfida. In risposta a recenti riflessioni che auspicano il ricorso ad un approccio clinico-neuropsicologico e la necessità di abbracciare nuove impostazioni teoriche e nuovi modelli, vengono messi in evidenza i principali elementi di criticità della valutazione cognitiva dell’anziano per poi illustrare come il modello della riserva cognitiva, il modello biopsicosociale e la visione “incarnata” del rapporto mente-corpo, aprano a nuove prospettive. Sulla base del Sistema Nazionale per le Linee Guida, promosso dall’Istituto superiore di sanità (ISS) e dal Centro nazionale epidemiologia, sorveglianza e promozione della salute (CNESPS), si immagina un possibile sviluppo di linee guida della valutazione cognitiva dell’anziano, utile a definire quali strumenti utilizzare nei diversi contesti di valutazione (ad esempio, valutazione di screening presso il medico di base, valutazione cognitiva presso centri specialistici, valutazione per l’assegnazione di una tecnologia assistiva) e con le diverse tipologie di utenti (ad esempio, soggetti con afasia).
For people living with some sensory or cognitive impairment, including many older adults, the disabling or empowering effects of physical and social settings can be crucial. An inclusive environment that nurtures participation is based on considering the needs of an individual alongside the affordability and social constraints, employing available technology and knowledge in efficient manners. While the assistive IoT and smart environments may offer unique opportunities, they may share similar issues with many other contemporary approaches and AT that stay as prototypes, hindering their adoption and widespread employment. This chapter presents some of the implementations of the IoT and smart environments for aged care and empowering people living with dementia or some sensory impairment. It also discusses some of the challenges regarding their deployments.
Our perception of the world and what goes on around us is a function of obtaining information through our senses, which is then processed and interpreted through the use of our cognitive abilities and memory. Mobility is also dependent on perception, along with the motor and other skills and abilities. While we heavily rely on our sensory and cognitive abilities, their imperfections and impairments are part of the human life. They can occur due to genetic reasons, illness, trauma, injury, or age. Nevertheless, sensory or cognitive impairments can affect human experiences and quality of life. For instance, the ability to move about or travel independently is a human desire. This desire holds for all individuals, including those who are blind or visually impaired. For many seniors, particularly for those living with dementia, memory loss or decline can be a highly distressing experience. Furthermore, many people with sensory, cognitive, or motor impairments often encounter numerous barriers in their daily life. In this chapter, after considering the scale and the effects of sensory impairments, dementia, and aging, the main views on disability will be presented. It will then contemplate on the AT requirements and the disability and aging experiences. These lead to detailed discussions on how technology in general, and the IoT in particular, can be of value in enhancing human experiences and quality of life.
Institute of Electrical and Electronic Engineers (IEEE) and one of its Future Directions team have initiated work on “digital senses” based on technologies that relate to various human sensory systems. One of the major objectives of this initiative is to promote alliances in the three focus areas of virtual reality, augmented reality, and human augmentation. Taking similar views, this part aims to show how combining the understandings about human senses with the advances in sensor technologies and the permeating nature of the IoT, can be of great value for aged care, cognitive assistance, and provision of disability services. The primary aim of these assistive devices and technologies is to enhance the functioning, independent participation, and overall quality of life for individuals. Some samples of such technologies, along with examples of the devices and systems that can be used in these contexts, are also discussed in this chapter. The discussions start with the traditional AT, then cover cognition assistance, and improvements of these two AT types through sensing to reach context-aware individualized ambient assisted living.
In this chapter, the assistive technology assessment (ATA) model has been presented. The ATA model outlines an ideal process that provides reference guidelines for both public and private centers for technical aid provision, allowing them to compare, evaluate, and improve their own matching model. The actions required by the ATA model to centers for technical aid can be divided into four fundamental steps: access to the structure and activation of the process, evaluation and activation of the aid/AT selection, delivery, and follow-up. The ATA is a user-driven process through which the selection of one or more aids/ AT is facilitated by the utilization of comprehensive clinical measures, functional analysis, and psycho-socio-environmental evaluations that address, in a specific context of use, the personal well-being of the user through the best matching of user/client and assistive solution (Scherer et al. Early Online). Because the ATA process and the MPT model and accompanying measures share a user-driven working methodology and embrace the ICF biopsychosocial model, they can be integrated within a path aiming for the best combination of AT to promote user/customer’s personal well-being.
Implementing psychophysiological measures is a worthwhile approach for understanding human reaction to robot presence in terms of individual emotional state. This paper reviews the suitability of using psychophysiological assessment in human-robot interaction (HRI) research. A review of most common psychophysiological parameters used in a controlled laboratory setting is provided and advantages and challenges of their utilization in HRI experiments are described. Exemplar studies focused on the implementation of psychophysiological measures for the evaluation of the emotional responses of the participants to the robots’ presence are described. Based on the reviewed literature, the paper also describes the results of our own research experience to make the most of the emerged recommendations. We planned and performed a study aimed at implementing psychophysiological measurements for assessing the human response of two groups of older adults (Healthy vs. Mild Cognitive Impairment subjects) towards a telepresence robot. Finally, the paper provides a summary of lessons learned across the field in using psychophysiological measures in HRI studies.
With the growing demand for digital information in health care, the electronic medical record (EMR) represents the foundation of health information technology. It is essential, however, in an industry still largely dominated by paper-based records, that such systems be accepted and used. This research evaluates registered nurses', certified nurse practitioners and physician assistants' acceptance of EMR's as a means to predict, define and enhance use. The research utilizes the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical model, along with the Partial Least Square (PLS) analysis to estimate the variance. Overall, the findings indicate that UTAUT is able to provide a reasonable assessment of health care professionals' acceptance of EMR's with social influence a significant determinant of intention and use.
Chronic illnesses impose a great burden on the lives of citizens worldwide. In modern health-care, decentralisa-tion, dehospitalisation and self management of diseases at home are crucial factors for improving the every-day life of the patients and the people close to them. People in general tend to dislike obtrusive monitoring on their daily activities, so the challenge for home care solutions is to implement systems that provide clinicians with adequate and concise information on their patients' health status while at the same time be unobtrusive and easy to use. Moreover, such systems must ensure that they produce high impact warnings on the patient's status only when it is needed, in order to relieve clinicians from unnecessary workload and become a real tool for decision making and efficient patient follow-up. ALADDIN's objective is to develop a trustworthy and reliable system supporting patients with dementia and their informal carers in the management of the disease from home. Based on a set of monitoring parameters and measuring scales feeding a reconfigurable Event Detection mechanism used for Risk Assessment and Analysis, the system aims to early detect symptoms that predict decline, avoid emergencies and secondary effects and, ultimately, prolong the period that patients can remain safely cared at home. Informal carers are also closely monitored by the system whereas additional features supporting networking, education and cognitive stimulation are also integrated along with decision sup-port and patient management tools for the treating clinicians. The platform has been built based on credible methodologies for efficient patient follow-up, risk detection and adaptive care. It is an open, secure, interoper-able, integrated IT-solution designed according to Service Oriented Architecture principles. The benefits of this platform are expected to lie in the prevention of emergencies, in reduction of carer burden and in maintenance of the patient's and carer's quality of life.
The concept of user-centred systems design (UCSD) has no agreed upon definition. Consequently, there is a great variety in the ways it is applied, which may lead to poor quality and poor usability in the resulting systems, as well as misconceptions about the effectiveness of UCSD. The purpose of this paper is to propose a definition of UCSD. We have identified 12 key principles for the adoption of a user-centred development process, principles that are based on existing theory, as well as research in and experiences from a large number of software development projects. The initial set of principles were applied and evaluated in a case study and modified accordingly. These principles can be used to communicate the nature of UCSD, evaluate a development process or develop systems development processes that support a user-centred approach. We also suggest activity lists and some tools for applying UCSD.
Assistive technology has the potential to enhance the level of independence of people with dementia, thereby increasing the possibility of supporting home-based care. In general, people with dementia are reluctant to change; therefore, it is important that suitable assistive technologies are selected for them. Consequently, the development of predictive models that are able to determine a person's potential to adopt a particular technology is desirable. In this paper, a predictive adoption model for a mobile phone-based video streaming system, developed for people with dementia, is presented. Taking into consideration characteristics related to a person's ability, living arrangements, and preferences, this paper discusses the development of predictive models, which were based on a number of carefully selected data mining algorithms for classification. For each, the learning on different relevant features for technology adoption has been tested, in conjunction with handling the imbalance of available data for output classes. Given our focus on providing predictive tools that could be used and interpreted by healthcare professionals, models with ease-of-use, intuitive understanding, and clear decision making processes are preferred. Predictive models have, therefore, been evaluated on a multi-criterion basis: in terms of their prediction performance, robustness, bias with regard to two types of errors and usability. Overall, the model derived from incorporating a k-Nearest-Neighbour algorithm using seven features was found to be the optimal classifier of assistive technology adoption for people with dementia (prediction accuracy 0.84 ± 0.0242).
Goal-Directed Task Analysis is being applied to assessing the needs and requirements for developing novel techniques and tools to permit a small number of humans to supervise large robotic teams. The paper presents a preliminary overall goal hierarchy as well as a preliminary communication goal hierarchy based upon the initial analysis. This research involves working directly with the Nashville Metro Police department's Bomb Squad and the Nashville Metro Fire Department's HAZMAT team. The focus is the assessment of actual user needs and requirements employing well-defined user centered design practices in combination with Goal-Directed Task Analysis. The resulting Goal- Decision-SA structure will be employed to develop potential human-robot interaction designs for further qualitative and qualitative evaluation. The objective is to successfully integrate robots into the Chemical, Biological, Radiological, Nuclear and Explosive device search and rescue tasks such that the robots complement and augment the current human capabilities.