Distributed Cognitive Aid with Scheduling and Interactive Task Guidance Edmund LoPresti, AT Sciences LLC Ned Kirsch, University of Michigan Debra Schreckenghost, Metrica TRACLabs Richard Simpson, University of Pittsburgh

Goals Clinician Caregiver Client - Determines techniques to counter impairment - Evaluates client condition and effectiveness of aids Maintain autonomy of lifestyle in face of traumatic cognitive impairment - Ensure client performs important tasks - Assist when client has problems ICue

Activity Assistant Remote Information Server ICue Architecture Cognition Manager HTN Planner for Schedules Reactive Planner for Instructions Instruction Database Plan Database Design Assistant Plan Editor (Java) Instruction Editor (Java) Clinician/Caregiver’s Office/Home Client’s Home

Design Assistant Clinician Builds 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) Clinician Instruction Database XML

Caregiver Builds Client Plans Caregiver Design Assistant Plan Database 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

Identify Activities for Schedule Available Tasks Task Attributes

Add Priorities & Time Constraints Task List Timing Required/preferred Priority

ICue Builds the Client Plan

Review/Adjust Plan

Task Stored as XML Stored for later retrieval when a task becomes active Stored for later retrieval when a task becomes active Transitioning from proprietary XML to AIMS-XML standard Transitioning from proprietary XML to AIMS-XML standard Developed by AbleLink and RERC-ACTDeveloped by AbleLink and RERC-ACT Allow sharing between devicesAllow sharing between devices

ICue Tracks Schedule and Tasks Design Assistant XML Instruction Database Plan Database Cognition Manager Activity Planner Instruction Sequencer

Activity Assistant ICue aids Client with Daily Tasks Remind client when time to perform task Step through task instructions Provide alternative instructions when client has difficulty Track whether client completes activities Client Cognition Manager HTN Planner for Schedules Reactive Planner for Instructions

Preliminary Data: Field Trial ICue prototype was used by a participant having cognitive impairment following TBI. 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.

Preliminary Data: Usability Survey 6 clinicians defined tasks for hypothetical clients ICue seemed beneficial (mean score of 4.2 out of 5 for 2 questions) Ease of use was mildly positive (mean scores of 3.7, 3.2, 3.7, and 3.7 for 4 questions); participant responses and investigator observations indicated usability issues to be addressed. Some concern that ICue might take too long to use in a clinical setting (mean 2.5 out of 5). Using ICue was not frustrating (mean score of 1.7 on a scale of 1-5 for frustration) and was worth the effort to use (mean 4.3 out of 5).

Future Work: Feedback to Client/Caregiver Real time (for situations ICue cannot handle automatically) Logged data for later review; potentially increase or decrease level of cues based on client’s performance.

Future Plans: Testing Formal clinical testing Formal clinical testing Usability trials with non-professional caregivers Usability trials with non-professional caregivers

Future Plans: Internet Risk Factors Loss of connectivity Loss of connectivity Privacy Privacy

Future Plans: Context Appropriate Cueing Address behavioral issues Provide simple prompts at regular intervals (e.g. pay attention, relax, speak more, speak less) Provide support to vary these cues (wording and/or frequency) based on what is or is not appropriate in different contexts 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

Discussion / Question 1 What are the biggest challenges/obstacles in automated task guidance? A.B.C.D.E.

A.B.C.D.E.

Discussion / Question 2 What technologies or techniques should be integrated to support caregivers? A.B.C.D.E.

A.B.C.D.E.

Discussion / Question 3 What broad categories of context might be important in behavioral cueing? A.B.C.D.E.

A.B.C.D.E.

Acknowledgements Work thus far: NIH SBIR #5 R43 HD Environmentaly Appropriate Cueing RERC-ACT, NIDRR Grant #H133E040019