Scheduling Accessory Assists Patients with Cognitive
Disorders
Health and Medicine
Originating Technology/NASA Contribution
Neuropsychology is the study of how the brain relates to
behavior, emotion, and cognition. Clinical neuropsychologists
evaluate the behavioral effects of neurological and developmental
disorders stemming from brain injury, strokes, multiple
sclerosis, Alzheimer’s disease, and Parkinson’s disease.
Millions of Americans are currently living with these cognitive
disorders, including a growing number of veterans returning
from Iraq with brain injuries. The disorders often result
in cognitive impairments which make it difficult to plan
daily activities and stay on task, affecting independence,
quality of life, and employment.
In the early 1990s, Richard Levinson, a NASA contractor
and senior researcher in Ames Research Center’s Artificial
Intelligence Research Branch and Autonomous Systems Group,
took the science in an entirely different direction when
he folded it into his NASA work.
Levinson, who had previously received a Space Act Award
for contributing to the development of a prototype autonomous
thermal control system for the International Space Station,
initially learned about neuropsychology accidentally. Moving
into a new apartment in 1986, he received a neuropsychology
course program in the mail that was actually intended for
the previous occupant. The topic intrigued Levinson, and
the pursuit to learn more was on.
As Levinson learned about emerging neuropsychological models
of human planning, he continued researching computer models
of automatic planning. A central concern for both fields
is that plans often change when surprises occur. Neuropyschologists
study how this integrated planning and execution breaks
down as the result of cognitive impairment, but they do
not know exactly how planning occurs in the brain. On the
other side, computer scientists can build a planning system,
but have a limited understanding of how to integrate planning
with execution monitoring and error recovery.
Levinson studied the neuropsychology of human planning
and applied this knowledge to his NASA research in order
to increase autonomy for spacecraft and robots. Since spacecraft
and robots operate in uncertain conditions, they cannot
be preprogrammed for every activity, so there are times
that they must be responsible for their own “health” and
safety. Further, as NASA’s missions grow more complex,
so does the Agency’s need for machines that can exhibit
a higher degree of independence and execute improvised
actions in novel situations where preprogrammed commands
will not work.
In 1995, Levinson published peer-reviewed research papers
in computer science and neuropsychology journals, describing
an artificially intelligent planning and reaction model
founded on neuropsychological theories of human behavior.
This planning and reaction model was based on the functioning
of the human brain’s frontal lobes, which play a part in
memory, motor skills, planning, decision making, and socialization,
among other functions.
Levinson has since received three patents for the technology,
pertaining to activity planning and cueing methods with
execution monitoring and error correction.
While Levinson and NASA continue to investigate this advanced
computer model for future missions, the technology has
already made its terrestrial debut in the form of a powerful
cueing and scheduling aid to help people with a wide range
of cognitive, attention, and developmental disorders.
Partnership
Levinson received initial funding from NASA and his contracting
company, Recom Technologies Inc., of Roseville, California,
to research the commercial potential of his artificially
intelligent planning reaction model to serve as a tool
for helping individuals suffering from various forms and
levels of brain impairment. In 1993, the chief of Ames’
Artificial Intelligence Research Branch suggested that
Levinson contact Santa Clara Valley Medical Center, which
hosts a nationally acclaimed rehabilitation and research
center that specializes in brain injuries, to see if the
hospital was interested in a research collaboration. Levinson
heeded the advice and found a valuable partner in the medical
center. This partnership led to further development of
Levinson’s technology and funding to support clinical research
from the U.S. Department of Education’s National Institute
on Disability and Rehabilitation Research.
In 1996, Levinson founded Attention
Control Systems Inc.,
in Mountain View, California, to produce and market this
NASA spinoff creation.
Product Outcome
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PEAT
is a powerful cueing and scheduling aid to help
people with a wide range of cognitive, attention,
and developmental disorders. |
Attention Control Systems now offers people with memory,
attention, and cognitive disorders a computerized, personal
planning device to help them stay on task by overcoming
limitations in planning and fulfilling their daily schedules.
The device, called the Planning and Execution Assistant
and Trainer, or PEAT, is a pocket-sized PDA, complete with
a graphical display, touchscreen controls, an electronic
calendar, an address book, and a built-in phone. The functionality
of PEAT, however, transcends that of a regular PDA scheduling
device. PEAT cues users to start or stop scheduled activities,
monitors their progress, and adjusts schedules as necessary
in response to delays or calendar changes. It uses the
automatic planning model developed for NASA to make automatic
adjustments to daily plans when a situation changes. Most
PDA systems lack this flexibility, requiring their users
to manually re-plan and update schedule data when changes
occur.
While daily routine activities come naturally to most,
individuals with memory, attention, and cognitive impairment
may struggle to remember that they have to perform certain
tasks. Those with severe impairment to the point where
independent living is a challenge are affected most, as
they may not only forget to perform tasks, but forget how
to perform them.
Whether individuals are mildly or severely impaired, PEAT
makes it easier for them to get through their planned schedules
by providing cues for task completion and adjusting for
unplanned schedule conflicts. PEAT can automatically shift
flexible tasks that do not require an exact start time
in order to keep the prioritized, scheduled events on track.
For example, an individual using PEAT wakes up to a preplanned
day that consists of having breakfast with a family member
from 9:30 to 10:30, followed by stopping at the bank, and
then seeing a 12:00 matinee show with a friend (the individual
receives cues from PEAT to inform him/her of all of these
scheduled tasks). This agenda was preprogrammed in the
user’s device (either programmed by the user or by a caregiver,
depending on the degree of impairment), with
breakfast and the movie being the top-priority scheduled
tasks, and the bank trip being a secondary, unscheduled
routine task.
Not everything goes as planned, however. It turns out that
breakfast takes longer than the scheduled hour, so the
user does not have time to stop at the bank before the
movie. Since the bank trip did not require an exact start
time, it is a task that PEAT can automatically shift to
another available time. This way, the task, though delayed,
is not ignored and will not be forgotten, and the individual’s
priority tasks—breakfast and the movie—are not interrupted.
The automatic cues that PEAT delivers to its users to start
and stop activities can be in the form of customized voice
recordings, sounds, and pictures; extra large text and
pictures help users with visual and motor problems. Cueing
continues until the user responds. Additionally, users
can program customized scripts (activity sequences) for
breaking large tasks into multiple, small tasks. This feature
is especially helpful for highly impaired users who may
find difficulty completing tasks such as getting dressed
in the morning or fixing themselves a meal.
PEAT’s Cue Card display provides a countdown timer until
the next scheduled event and cues the user to start or
stop at the scheduled time. Highly impaired users may be
locked into this Cue Card section, which means they will
only see reminders for one event at a time. This mode keeps
the reminders simple and does not create unwarranted confusion
for these users. Other users with less impairment may have
the option to override cues by starting and stopping them
early, and can delay, skip, reschedule, or altogether cancel
the cues. The device keeps a log of all of these actions,
so that the caregivers and family members can evaluate
how well a user is adapting to the technology and accomplishing
real-world tasks. For the user, the accomplishments boost
independence and confidence, and diminishes cost of care.
“PEAT can be simplified by hiding features so that highly
impaired users will use a system with far less features
than higher-functioning users,” stated Levinson. “We start
off simple with each user and add options over time. In
some cases, a caregiver or therapist sets up the schedule
and the user must only respond to cues, while PEAT monitors
their progress and automatically adjusts the schedule as
necessary,” he added.
PEAT is sold as a complete system that includes software,
hardware, documentation, and technical support. In addition
to the flagship Pocket PEAT device, there is PEAT Phone:
software that runs on cellular phones; PC PEAT: software
that runs on desktop and laptop PCs, where the larger screen
and keyboard may be used to configure the system, enter
data, train users, and back up data; and PEAT Link: software
that links the Pocket PEAT device to PC PEAT for software
copying and data transfer.
PEAT is currently providing planning and execution assistance
to patients at Department of Rehabilitation facilities
in 25 states, Santa Clara Valley Medical Center, the U.S.
Department of Veterans Affairs’ Palo Alto Health Care System,
and to school districts and assistive technology centers.
At the Palo Alto hospital’s Polytrauma Rehabilitation Center,
Dr. Harriet Zeiner, lead clinical neuropsychologist, has
developed treatment protocols for troops returning from
overseas with mild traumatic brain injuries from improvised
explosive devices, as well as for soldiers with post-traumatic
stress disorder. Zeiner’s treatments include using the
PEAT device as a memory prosthesis.
Meanwhile, clinical studies of PEAT continue
at Santa Clara Valley Medical Center. Levinson also
foresees the technology he first developed for autonomous
robotic planning to have “spin-in” application for NASA’s
astronauts.
PEAT™ is a trademark of Attention Control Systems Inc.
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