Assistive Technology for Promoting Physical and Mental Exercise to Delay Progression of Cognitive Degeneration in Patien

1. SIBHI 2007 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 Advisors: Dr. Debnath Dr. Riley-Doucet

2. 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 Alzheimer Background Source: Wikipedia.com

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

4. 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”

5. 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 for the Elderly

6. 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 Benefits of Exercise Continued…

7. A Distorted Perception

8. 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

9. 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

10. Requirements and Considerations for Design • Usability and Interfacing • Adaptability • Portability • Reliability • Price • Safety

11. Our Research • Exercise Physiology • Cycling and Ergometry • Visual Priming • Cues • Multi Stimulatory Effects • Lights

12. 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! Cycling and Ergometry Source: Brookstone Inc.

13. 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). Visual Priming

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

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."

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17. Do you feel more relaxed? 

18. Targets of the Game • Cognitive stimulation • Memory • Matching • Problem solving • Judgment • Recollection Goal of the gameSubdue cognitive deterioration

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

20. 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

21. 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

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

23. 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). Solution

24. 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

25. Role of the Microcontroller Source: Wytec Inc. 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: Digi-Key Corporation

26. Transducer that varies its output voltage in response magnetic field density Commonly used to time the speed of wheels and shafts Source: www.wikipedia.com/hall_effect_sensor Hall Effect Sensor

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

28. 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

29. 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 Device Design (Output)

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

31. 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 Monetary Demands…Please 

32. 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

33. 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)

34. 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.

35. Questions?