1. A Multifaceted Approach to Cognitive Health Coaching
Tampere
University of
Technology
A Multifaceted Approach to Cognitive Health Coaching
Holly Jimison, PhD, FACMI
Professor, College of Computer & Information Science
Bouve College of Health Sciences
Northeastern University, Boston MA
Funders: Alzheimer’s Assoc.,
Intel, NSF, NIA, NIST,Tekes

2. Oregon Center for Aging & Technology
ORCATECH
Oregon Health & Science Univ
Neurology
Biomedical Engineering
Medical Informatics
Point of Care Laboratory
Aging & Alzheimer's Disease Center
Academic Partners
Oregon State University
Portland State University
University of Oregon
Industry Partners
Intel
Spry Learning Co.
Service Partners
EliteCare, Inc
Pacific Retirement Services
Other Partners
AARP
Oregon State Government
CAST
ORCATECH

3. ORCATECH Living Lab Living Lab – Community dwelling seniors
Portland area
Living independently
Used to test technologies to support independent living and provide scalable quality care in the home setting
ORCATECH

4. Team Members Holly Jimison – PI Northeastern; Paul Gorman – PI OHSU
Misha Pavel, Tamara Hayes – BME faculty, Co-I’s
Nathan Bahr, Bill Hatt, Jon Yeargers – Software Development
Jennifer Marcoe, Susan Butterworth – Health Coaches
Zephy McKanna, Stuart Hagler, Krystal Klein – Computational Cognitive Models
Donald Young – Project Mgt., Collaborative Medication Adherence
Nicole Larimer – Living Lab Manager, IRB interface
Sue Scott – PT, older adult exercise consultant
Yves Vigmenon, Steve Williamson – Mobile / Med Mgt
Michael Shapiro, Chow Yu, Tony Grecco, Andi Lushaj – MS Theses
ORCATECH

5. Scalable Approach to Delivering Cognitive Interventions to the Home
Cognitive exercise is a lifestyle intervention
Remote, just-in-time, continuous care
Incorporate principles of health behavior change
Optimal use of lower cost personnel
Integrate family & informal caregivers into the health care team (untapped resource)
Platform for testing sustained cognitive interventions in the home

6. Modular Software for Multiple Protocols
Cognitive Exercise (computer game format)
Novelty exercise
Physical Exercise
Sleep Management
Socialization
Medication Management
Mood Management (depression)

7. Home Monitoring Data

8. Health Coaching Platform Information Flow

9. Health Coaching Platform Information Flow
Family Interface
Safety monitoring
Soft alerts
Team-based care
Socialization

10. Participant Home Page Participant home page Messages from coach
Featured story
Weekly goals
Activities
Surveys
Access modules
Physical Activity
Sleep
Socialization
Novelty Mental Exercises
Cognitive Games
Coaching Process
Participant Materials

11. Cognitive Computer Games - embedded monitoring algorithms

12. Example: Computer Game to Measure Executive Function

13. Model the timing of the mouse clicks
Recall
Next Target
Search for
Next Target
Move to Next Target
S. Hagler et al.,

14. Estimates from Game Predict TMT Scores
S. Hagler et al.,

15. Cognitive Modeling Example: MemoryB A C D E F G H I
Characterize Memory Capacity
Intervening number of events
Intervening time
Memory load
Simple Memory Model: Discrete Buffer
Characterize Memory Capacity
with a Single Parameter
M Pavel, et al.,

16. Physical Activity Module
Access safety information, videos, self-report activities, progress, maps of walking routes! User interface. Monitors and records progress.
Modules all start with a survey and then move into customized/tailored program based on that information. Coach and participant work together.

17. Physical Activity Module-continued

18. Interactive Video Exercise Using Kinect
In this collaboration, we are working on building a semi-automatic system for remote coaching of elderly people.
This requires installing the system into patients’ homes.
And, we decided to use Kinect for this purpose since it is easy to install and maintain, and its price is right.
However, quite often, we have been asking ourselves the question:
“How accurate is the Kinect pose?”
“How much can we trust the Kinect pose estimation?”
9/23/2018

20. Automated Evaluation / Feedback on Exercises
ORCATECH

21. Sleep Module Assessment Sleep Hygiene Anxiety Circadian Rhythm
Tailored Intervention

22. Socialization Protocols for Cognitive Health
Web cams and Skype software given to participants and their remote family partner
Frequent spontaneous use among participants

23. Why Socialization?
Poor socialization is a health risk Comparable to smoking, greater than obesity
Meta-analysis of 148 articles: “individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships”
Holt-Lunstad, J., Smith, T.B. & Layton, J.B. Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7, e (2010).
Social ties enhance both physical and mental health
Social isolation is linked to cognitive decline
Socialization is not addressed by conventional medical care
ORCATECH

24. Results: Skype Usage Usage Ave 1 hr/wk Peak in week 3 Contacts
Ave 5 contacts each
Range of 2-10
Some technical challenges
All saw a benefit
Most compelling part of our set of interventions
Serendipity: Assigned family contacts were often not available. Many participants recognized others from the study on the Skype list, initiated contacts and developed friendships.

25. Socialization Module

26. Socialization Module Protocol

27. Socialization Module Protocol

28. Socialization Module Protocol

29. Socialization Module Protocol

30. Socialization Protocols – Level 1 options
Technology
Activity
Freq
Computer
Make a Skype call to family member, friend, study participant, or coach
1-3 / wk
Participate in group Skype call
1 / wk
Send to family member, friend, study participant or coach
1-3 /wk
Participate in online support group or chat
Play online card or board game with others
Use Facebook – new interaction
Phone
Make a phone call to family member, friend, study participant, or coach
In Person
Visit with family or friends
1-2 / wk
Play a board or card game with someone
Participate in a community event
Participate in a volunteer activity
Walk in a public place (mall, park) for at least 10 minutes

31. Benefits of Approach to Cognitive Health Coaching
Scalable approach to delivering health care to the home
Extends the reach of lower cost professionals
Incorporates family and patient into the care team
Timely and continuous
Cognitive monitoring and potential remediation
Most important aspect of health to older adults
Aim to keep people independent ( QoL &  costs)
Cognitive Health Coaching System can serve as a framework for testing the best delivery of cognitive interventions

32. Conclusions: Lessons Learned
Algorithm Issues
New analytic models for developing behavioral markers derived from sensor data
Dynamic user models
Tailored message generation
Privacy / Security – Tailored data sharing
User centered design – ease of use
Protocol Issues
Need to have a variety of activities for novelty and sustained engagement
Coaching (automated and in-person) important

33. Questions? Suggestions?
Contact: Holly Jimison, PhD, FACMI
Medical Informatics / OHSU
OBSSR / NIH
Northeastern University, Boston

34. Activity Monitoring in the Home
Sensor Events
Private Home
Bedroom
Bathroom
Living Rm
Front Door
Kitchen
This is an example of the kind of data we can obtain (which cannot be obtained with conventional research methods).
Hayes et al., orcatech.org
Hayes, ORCATECH 2007

35. Models to Infer Activities of Daily Living
Pavel et al., IEEE Special Issue, in press

36. Measuring Gait in the Home
Unobtrusive gait measurement in-home with passive infrared (PIR) sensors - Hagler, et al., IEEE Trans Biomed Eng, 2010
Four restricted view PIR sensors
Measure gait velocity whenever a
subjects passes through the
“sensor-line”
Deployed for the Intelligent
Systems for Assessing
Aging Changes (ISAAC) study
200+ subjects monitored for up
to 4 years

37. Subject 1
Austin et al, Sept EMBC (Gait)

38. Subject 2
Austin et al, Sept EMBC (Gait)

39. Overview of Methods for Health Coaching
Needs Assessment
Interviews & focus groups with patients, family caregivers, home health workers, clinicians, nurse care managers, payers
Interview researchers/experts with an interest in deploying and evaluating a health intervention in a home environment
Clinical / Behavioral Protocol Development (Cognitive)
Design Specifications
System Development
Implementation / Usability Testing / Stakeholder Feedback
Test in Homes of Elders

40. In-Home Cognitive Health Coaching Studies
Needs Assessment – Focus groups & interviews
Older adults
Caregivers (formal and informal)
Industry (developers, service providers, policy makers)
ORCATECH 40

41. In-Home Cognitive Health Coaching Studies
Needs Assessment
Coach Messaging Study
5 Health Coaches
Compared automated messages with hand crafted messages
Time
Quality - both elders and other coaches evaluated quality
ORCATECH 41

42. In-Home Cognitive Health Coaching Studies
Needs Assessment
Coach Messaging Study
Ongoing Usability Testing
In lab early testing for game selection / development
In home testing for early iterative design
New – remote testing of both coach and patient interface
ORCATECH 42

43. In-Home Cognitive Health Coaching Studies
Needs Assessment
Coach Messaging Study
Ongoing Usability Testing
Feedback on Cognitive Games and Novelty Exercises
13 Living Lab Subjects
9 women (69%) and 4 men (31%)
Average age 76.7 ± 8.2
Health concerns: mixed, many chronic conditions
Automated tailored message prompts for coaching
Coaching activities: recommended targets to achieve goals, weekly + s, respond to questions and comments from participants
ORCATECH 43

44. In-Home Cognitive Health Coaching Studies
Needs Assessment
Coach Messaging Study
Ongoing Usability Testing
Feedback on Cognitive Games and Novelty Exercise
ETAC Coaching Study
20 participants in the ORCATECH Living Lab
Average age 78.3 ± 7.8 years
70% female
Added physical exercise, socialization & sleep management
ORCATECH 44