Distributed Cognitive Aid with Interactive Task Guidance

Edmund F. LoPresti1,4, Ned Kirsch2, Debra Schreckenghost3, Richard Simpson4

1AT Sciences, Pittsburgh, PA; 2University of Michigan; Ann Arbor, MI; 3Metrica/TRACLabs; Houston, TX; 4University of Pittsburgh, Pittsburgh, PA

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Goals

ClinicianClinician CaregiverCaregiver

ConsumerConsumer

-Design cues to assist with daily tasks

-Assess ability to follow cues

Maintain autonomy of lifestyle in face of traumatic cognitive impairment

- Help family member or client structure his or her day

- Receive feedback on consumer’s activity level, safety

- Provide assistance in emergencies

ICueICue

Activity Assistant

Cognition Manager

ICue Architecture

Planner for Schedules

Reactive Planner for Instructions

Design Assistant

Plan Editor(Define Client

Schedules)

InstructionEditor

(Define Task Instructions)

Clinician/Caregiver’s Office/Home

Client’s Home

Remote Information Server

Clinician Defines Task Instructions

1.Define steps of task

2.For each step, identify an instruction to aid client

3.Order the steps into a sequence

4.Define how client errors should be handled (alternative instructions, call in help)

Caregiver Defines Client Schedules

1.Identify activities for next day(s)

2.Add priorities and temporal constraints

3.ICue suggests a client plan

4.Adjust planning criteria to build a better plan, if desired

Task List

Timing

Priority

ICue Aids Client with Daily Tasks

• Remind client when its time to perform a task

• Step through task instructions

• Provide alternative instructions when client has difficulty (based on client feedback or lack of feedback)

• Track whether client completes activities (based on client feedback); log can be reviewed later by clinician

• Update plan if problems arise

• Call for real-time help from caregiver if needed

ICue development was funded by National Institutes of Health SBIR #5 R43 ICue development was funded by National Institutes of Health SBIR #5 R43 HD44277-02. Work on environmentally-appropriate cueing will take place as Task HD44277-02. Work on environmentally-appropriate cueing will take place as Task D6 of the RERC on Advancing Cognitive Technologies, National Institute on D6 of the RERC on Advancing Cognitive Technologies, National Institute on Disability and Rehabilitation Research Grant #H133E040019.Disability and Rehabilitation Research Grant #H133E040019.

Field TrialICue was used by a consumer having a cognitive impairment due to traumatic brain injury. The participant was observed performing two individualized tasks with cues from ICue. The participant was able to respond appropriately to the cues provided by ICue, and was able to successfully complete each task without intervention from a clinician, whereas the participant was unable to perform either task independently without the intervention.

Usability Testing with Clinicians- 6 clinician participants defined tasks for hypothetical clients- Elements of user interface which caused problems were observed and logged by investigator- Participants completed a survey on ICue usability.

Question Mean/standard deviation

(maximum score of 5 for all questions)

It was easy to learn how to use the ICue Design Assistant.

3.7 / 0.82

Using the Design Assistant was a very frustrating experience.

1.7 / 0.52

It would take too long to use the Design Assistant to define tasks in a clinical environment.

2.5 / 1.38

My clients would benefit from a system such as ICue. 4.2 / 0.75

I frequently guessed correctly when trying to figure out what to do next.

3.2 / 0.98

Most of my actions while using the Design Assistant were correct.

3.7 / 0.82

It is worth the effort to use ICue. 4.3 / 0.82

I feel I am capable of independently using the Design Assistant with a client after this experience.

3.7 / 0.82

I would be likely to purchase ICue if it were a commercial product.

4.2 / 0.75

Future WorkEnvironmentally Appropriate Cueing

As a task in the RERC on Advancing Cognitive Technologies, ICue will be adapted to provide environmentally-appropriate behavioral cues. A user’s schedule will be enhanced with information about the social context of their tasks (home, work, school; alone, with friends, with co-workers; etc). A caregiver will be able to define behavioral cues (e.g. pay attention, relax, speak more, speak less) that will be provided on a repeating basis. A caregiver will further be able to instruct ICue to vary these cues (wording and/or frequency) based on what is or is not appropriate in different contexts or across contexts having similar social constraints (e.g., these are settings in which it is necessary to behave formally vs. those in which it is acceptable to be casual). For example, a cue required at home may not be the same as one required at work, while a cue required at work during lunchtime may be different than a cue required at work during a meeting).

Finding the most effective cue will require a certain amount of trial-and-error and training. ICue will include a user interface for the clinician that will assist in training ICue to provide appropriate cues to the client. While exploring the most appropriate cues with a client, the clinician will be able to trigger cues to be delivered immediately in response to the client’s behavior. Once appropriate cues are identified, the clinician will be able to set ICue to deliver these cues automatically and with sensitivity to social context.