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P3. Assistive technologies I

Detailed Programme, abstracts and presentations

P3. Assistive technologies I (Friday, 5 October, 14.00-15.30, Europa 3)

P3.1. Does cognitive training with the use of a virtual museum improve neuropsychological performance in aMCI?

Tsatali Marianna, Tarnanas Ioannis, Malegiannaki Amaryllis-Chryssi, Tsolaki Magda

Introduction: The revolution of the digital technologies in the past has focused mainly on the technical power and not on the semantic level of the informative and communicational aspects. After an early period of inflated expectations and limited delivery, Virtual Reality Technology is now beginning to emerge as a viable tool for mental health applications. Virtual environments (VE) have been developed which are now demonstrating effectiveness in the areas of clinical psychology and neuropsychology (Hodges et al., 1996). In our study, the virtual reality museum was designed to enhance auditory processing, working memory, improve speed of information processing and reengage neuromodulatory systems that mediate learning and memory. To reverse cognitive disuse and drive brain plasticity, the program strongly engages the brain with demanding exercises and an adaptive and reward-based daily training schedule. Based on decades of research on brain plasticity (the ability of the brain to remodel itself throughout life in response to behaviorally important stimuli) in animals and humans (e.g. Mahncke et al., 2006), a couple of plasticity-based computerized training programs with promising results have recently been developed (M. Franco-Martín et al., 2011). The current study intends to test whether participants who attended the virtual reality museum program (“Vrmuseum”) can achieve better cognitive status and general functionality compared to the control group, who has not been exposed to any program.

Methods: Data concerning cognitive performance were recorded from 40 patients with amnestic Mild Cognitive Impairment (aMCI) during 2010-2012. Participants were further subdivided in 2 groups: the training group that attended the “vrmuseum” program and the control group had been placed on a waiting list. Statistical analyses were carried out using x2and Mann-Whitney methods.To evaluate neuropsychological status we used MMSE, Trail B, FRSSD and Rey Figure.

Results: Intent-to-treat analyses, controlling for age, education, and cluster randomization were adopted. According to results, there was a significant improvement of visuospatial memory performance in the training group (p = .042 immediate recall and p = .036 later recall), whereas there has not been observed any changes in general mental and functional performance between the two groups.

Discussion: In conclusion, aMCI patients who participated in the Vrmuseum program outperformed the control group regarding visuospatial memory, suggesting that the present form of virtual reality training improves neuropsychological performance selectively on task related abilities. We plan to use the annual conversion rate (ACR) in order to calculate the relative risk reduction investigating the Conversion rate of subtypes of aMCI to AD after using the “Vrmuseum” for 14 months in total.

P3.2. Kodro: a new application for seniors.

Alain Pesce, Frédéric Couriol, Dominique Harrouët, Philippe Migliasso, Patrick Bonarrigo, Jean-Michel Campolmi, Cyril Atcha, Solange Hesse, Kévin Polet

We present a new I.T. application, called KODRO, which may ensure a higher quality of life in elderly patients especially those who complain of memory loss, and those with early/mild Alzheimer's disease.

Kodro, developed on iPad2 tablet computer, uses a systemic approach based on : information, cognitive stimulation, link with the others (families, friends), improvement of quality of life and social life, prevention (with advices about fitness, nutrition...), advices and information for care givers and families.

Kodro offers a personalized internet interface which permits a cognitive dynamic interaction, and a social network development. Indeed the person/patient, carriers, relatives, friends… may be related together and share information and news thanks to KODRO. Moreover a « Kodro helper » could help with the interface, gives encouragements, and incites person/patient to use the tool.

When person/patient begins to use Kodro, a discovering visit is programmed: during the time of the visit a cognitive evaluation is done which conducts to classify the person at a level. Following activities will be proposed in function of this level, but also in function of his specific preferences and needs. The KODRO « system » is based on a web technology allowing for interactivity and constant adaptation to the user. Only the « Kodro helper » will have knowledge of the level. The person/patient will still receive encouragements, and positive returns.

When connecting, the person will be aware of some propositions : Datebook to keep track of appointments and upcoming events; News (samples of local and national news, with possibilities to set topics preference or customize the e-newspaper page); Entertainment (audiobooks, TV series, documentaries); cognitive exercises (games, memory mobilization); « My Kodro » (visiting favorite location, adding some personal inputs in predilection domains); emailing … Moreover, everyday, a list of recommended activities is proposed in order to encourage person/patient to diversify activities and to discover new contents.

All the programs are developed with high specialized expertise, in order to be adapted to person/patient and helping them to fight the growing isolation of the elderly (a well known risk factor for cognitive impairment), to  stimulate cognitive functions, in an happy and ludic way.

We have been testing KODRO in a series of patients from our day care center in Monaco, in family carriers, and in voluntary elderly people. We observed that KODRO is also an interesting and adapted tool for day care center activities.

A special version dedicated to day care centers will be presented. We think that the use of such an I.T. in daily care center is able to gain time for care givers especially in reducing the time of preparation of activities. We know that animation activities, and also memory mobilization activities take a long preparation time (sometimes as long as the duration of the activity). Kodro proposes a large panel of interventions in a lot of domains ; and the animators and care givers may also select their own choice and propose personalized sessions.

P3.3. User evaluation of the ROSETTA assistive technology system for people with dementia

Franka Meiland, Bart Hattink, Tessa Overmars-Marx, Johan van der Leeuw, Irek Karkowski, Rose-Marie Dröes

Background and aim of the study: Assistive technologies are needed as alternative ways of support for the growing number of people with dementia and carers the coming years. In the European ROSETTA project assistive technology is developed to help people with severe memory problems or dementia to retain their autonomy and quality of life for a longer period of time and to support the carers. The aim of this evaluation study is to assess the user-friendliness, usefulness and impact of the ROSETTA system in daily life of persons with dementia and the informal carers.

Methods: A controlled trial is performed among people with severe memory problems and their informal carers in the Netherlands, Germany and Belgium. Participants in the experimental group received the ROSETTA system in their homes, and persons in the control group received care and support as usual. Data were collected with pre-test and post-test interviews, in between telephone interviews and home-visits, diaries and logging, and focus groups.

Results: 42 Persons participated in the study: 19 in the Netherlands, 11 in Germany and 12 in Belgium. Post-test data were available for 28 persons. Participants varied in actual usage of (parts of) the ROSETTA system. Preliminary results show that, although some problems with the system performance were perceived, positive effects were mentioned regarding feelings of safety of the carer and delay of nursing home admission of the person with dementia.

Conclusions: The ROSETTA system was developed in cooperation with the persons with dementia, carers and dementia experts. At the conference the final results will be presented regarding the user-friendliness, usefulness and impact of the ROSETTA system on autonomy and quality of life of persons with dementia and on burden, feelings of competence and quality of life of the informal carers.

P3.4. Paid Careworkers in Greece: A self study e-learning tool for the social homecare sector in Greece and Bulgaria

Areti Efthymiou, Eva Ntanasi, Licia Boccaletti, Dr Denitza Toptchiyska, Aristea Liarokapi, Nikos Rompampas , Dr Blagorodna Filevska, Dr Paraskevi Sakka

In Greece 80% of people with dementia are cared for at home often with the support of informal careworkers who normally are migrant women from the ex-Soviet Union and Bulgaria or Greek women with low education level.

The Greek and Bulgarian Vocational and Educational Training (VET) system currently does not offer a training program which could fit the needs of this category of employees which are: flexibility, low cost and surpassing language barriers.

To answer these needs, an e-learning tool, ASPASIA will be transferred from Italy to Greece and Bulgaria in the frame of a Lifelong Learning Program: Leonardo DaVinci – Transfer of Innovation Project. It focuses on themes such as: basic healthcare skills, basic assistance skills, relationship and communication with the elderly skills, rights and duties of the careworker, national health and service systems, strategies to deal with elderly people with Dementia and computer skills. The training program will be accessible through a web-platform and DVD.

To assess the needs of paid care workers in Greece, interviews were conducted with women from Bulgaria who have migrated to Greece and work at the homecare sector. Qualitative data were collected. The majority of the participants strongly believe that is very important for them to learn the Greek language in order to cope with the elderly and find the care of them easier than that of a child.

The research has provided us with results similar to that of the Italian population study where the ASPASIA project is implemented and widely accepted by careworkers.

P3.5. Telehealth for the diagnosis, assessment and management of dementia in remote in remote scottish communities

Anthea Innes and Louise McCabe

Objectives: The assessment and diagnosis of dementia often requires specialist staff input, this poses a particular challenge for remote and rural island and mainland communities. This paper will report on an evaluation of a telehealth initiative in Scotland where local clinicians worked with a specialist to provide a local assessment and diagnosis of dementia using video-conferencing technology (VC).

Methods: Three data collection methods were used. Structured questionnaires were used to gather information about the technical aspects of using telehealth. Structured, face-to-face interviews were conducted with people with dementia and their carers in two remote and rural locations of Scotland, the Shetland Islands and Grampian. The sample included people with dementia and their carers who had used the telehealth service and a sample of people who had used conventional services entailing travel to a specialist centre in a large city. Interviews with staff using telehealth and staff who were not using telehealth were also conducted.

Findings: The paper will discuss participants’ views on the VC and the variation in the follow up contacts or support they had experienced. Travel and access issues varied according to location and will be discussed in relation to the degree of remoteness of the rural community, personal preferences and ability to travel to appointments. Clinicians’ perceptions of the usefulness of the VC component of the memory clinic varied and will  be discussed in relation to service user experiences.

Conclusion: Telehealth can make an important contribution to dementia diagnosis and management in remote and rural areas. Telehealth on its own will not solve the issues; it needs to be used judiciously with local adaptation of services. Perceptions of difficulty of travel distances are relative to the degree of remoteness Memory services need to be tailored to individual preferences, whether they are clinic based, home visits or use technology.

P3.6. Tracking or talking? What do people with Alzheimer disease and their caregivers expect from assistive technologies? Example of a GPS-based tracking system.

Juliette Sablier, Vincent Rialle & Bertrand Robert

Objective: To understand the reasons of acceptance and rejection of a GPS-based tracking system by persons with Alzheimer Disease and Other Dementias (ADOD) and their caregivers.

Methods: Ten women and 13 men with ADOD (mean age=81.3; SD=7.3) were attributed a tracking system at home during at least 6 months (median duration of use=4 months). Their score at Mini Mental State Examination (MMSE) ranged between 15 and 26. Twenty-three caregivers (83% women) were also involved (mean age=60.1; SD=18.9). The system tested was composed of a watch equipped with tracking technologies, connected to a tele-assistance service available 24h. A Geofencing Area (GA) was determined with patient and caregiver, representing the location where the user was able to go safety. Alerts were sent to the tele-assistance service if this GA was left, when a Panic Button (PB) on the watch was pressed, or in case of Low Battery (LB). A tele-operator then called the caregiver in order to help solve the problem. After the period of use, the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST, Demers et al., 2000), which provides scores from 1 (not satisfied at all) to 5 (very satisfied), was filled with the users and their caregivers.

Results: Whereas 30 people with ADOD signed the consent form, 23 accepted the installation of the material at home, and only 13 elicited alerts. The main reasons of this attrition were the lack of perceived usefulness (n=9/30) and the stigmatizing appearance of the watch (more than 53% of the sample scored 1 to 2 for its dimensions and comfort at QUEST). The professional services were highly appreciated (4 to 5 points at QUEST) by 93% of the participants. The majority of alerts (38%) were PB alerts. Among the 30% of alerts due to leaving GA, 76% appeared in safety condition (user was accompanied or the activity outside the GA was previously planned).

Discussion: The perceived usefulness, which is known as being a core feature of technology acceptance by seniors (Biljon et al. 2009), could increase by organizing an adaptation period with regular assistance and a strong follow-up and also by providing a watch more elegant and less stigmatizing. However, it is unethical to make people choose between safety and aesthetics. On another hand, the main use of the BP, as well as the amount of alerts elicited in safety condition, and the appreciation of professional services are indicators of the need felt by patients and caregivers to talk to someone as much as to feel safe and to be continually supported by a human person. This should be considered by service providers.



Last Updated: Thursday 15 November 2012