Potential Application of Lifelogging Technology (SenseCam) in Rehabilitation Dr Fergus Gracey, Consultant Clinical Neuropsychologist Lara Harris, Louise Head, Kate Psaila, Cat Ford Oliver Zangwill Centre for Neuropsychological Rehabilitation NIHR CLAHRC for Cambridgeshire and Peterborough fg290@medschl.cam.ac.uk fergus.gracey@ozc.nhs.uk
Outline Conceptual framework for brain injury rehab linking executive function, memory and emotional adjustment What is SenseCam? Brief summaries of 4 rehab applications Jane - Memory problems and rehab Rose - Rehearsing a rehab task 1: confidence Lorraine - Rehearsing a rehab task 2: skills Allan - Enhancing benefit from cognitive therapy Enhancing Goal Management Training A service user s account of SenseCam in brain injury rehabilitation
What is neuropsychological rehabilitation? amelioration of cognitive, emotional, psychosocial and behavioural deficits caused by an insult to the brain (Wilson, 2007) Usually through compensatory approaches (i.e. finding ways of minimising the impact of the deficit in day to day functioning and quality of life) Preferably integrated with psychological therapy (Wilson and Gracey, 2009)
The Y shaped model (Wilson et al, 2009; Gracey, Evans and Malley, 2009) Social and self discrepancies Self under threat aspired to or old me plan do me now Safe to explore Test strategies and develop skills predict reflect observe possible new me Who might I be? How might things be better? Positive growth Contextualised support Exploring and consolidating the new me s
Selfregulation problems represent a double deficit Impaired abilities in day to day life Impaired abilities to engage in and make use of rehabilitation strategies
Self-regulation and rehab Emotional control Future-directed control (planning, problem solving, prospective memory) Ability to recall events in detail Cognitive control (working memory and attention) Selfregulation and adaptation Participation in valued roles and activities Gracey and Ownsworth (2012) potential impact of AM and EF deficits on response to therapy and rehab
What Is SenseCam? A small wearable camera Sensors record movement, position (GPS), colour, light temperature - Sensors trigger the camera Simple 2 button operation ( On, Privacy ) Developed by MicroSoft Research UK Now marketed by OMG Life as the Autographer www.autographer.com
Autobiographical memory and therapy Store of experiences that provide sense of self and continuity over time: mental time travel A particular self is activated in a situation: helps guide us and selfregulate Provides ability to think about a future situation Autobiographical memory Store of experiences that provide information about us, others and the world around us Store containing our experiences, feelings, thoughts in different contexts AM s feature in models of executive function Prompting use of AM might enhance problem solving after ABI Recalling an AM is emotional, not just information In CBT change requires recall of info and emotions
Research Plan NIHR Flexibility and Sustainability Funding Cambridgeshire PCT Cambridgeshire Community Services NHS Trust NIHR CLAHRC CP NIHR Brain Injury Health Technology Cooperative (Cambridge) Explore applications of SenseCam in neuropsychological rehabilitation Enhancing impact of rehab or therapy Executive functioning problems Emotion regulation problems Emotional adjustment and wellbeing User feedback and ideas
Outline Conceptual framework for brain injury rehab linking executive function, memory and emotional adjustment What is SenseCam? Brief summaries of 4 rehab applications Jane - Memory problems and rehab Rose - Rehearsing a rehab task 1: confidence Lorraine - Rehearsing a rehab task 2: skills Allan - Enhancing benefit from cognitive therapy Enhancing Goal Management Training A service user s account of SenseCam in brain injury rehabilitation
Jane engaging in rehab Severe memory impairment from TBI, major emotional adjustment issues Pre-injury very high functioning Intensive rehabilitation programme SenseCam to support Recall of and engagement in rehab Reflection on mobility and gait with occupational therapist due to fears of falling Recall of non-routine events
Memory score accuracy, expressed as a percentage of total events Number of facts recalled overall Mean % recall for events Number of facts recalled overall Jane SenseCam assisted recall 10 100 9 90 8 80 70 60 50 40 30 20 10 Without images With images 7 6 5 4 3 2 1 Same day recall without images Same day recall with images Following day recall without images Following day recall with images 0 Same day Following day 0 Generic emotional Specific emotional 100 90 400 80 350 70 60 50 40 30 300 250 200 150 Same day recall without images Same day recall with images Following day recall without images Following day recall with images 20 100 10 50 0 Following day recall without images Following day recall with images 0 Generic nonemotional Specific nonemotional
Jane - outcomes Initially not comfortable with the device it symbolised the problem it was designed to treat Not useful for routine rehab appointments: Notes, Filofax, materials from sessions Reviewing images of mobility SC failed to update her own fears of falling Video of her walking better Useful for recollection of non-routine events and specific emotions Cued recall appears better the day after Able to spontaneously recall more neutral memories Continues to use the device following rehab
Rose gaining confidence Mild TBI, difficult pre-injury emotional history Significant loss of social confidence post TBI Goals relating to going in to town going for a coffee, using the guided busway
Rose - outcome Completed trip on the guided busway with SenseCam Reviewed images at home Repeated the guided bus-way trip successfully independently Both singly and as a movie
Rose s feedback I was able to go over situations in the privacy of my own home to review things which I was uncomfortable with. the outside world can be very frightening and fast and I felt afraid and thought I would have difficulty keeping up I was able to review my visits into the outside world and practise at home and memorise different situations and how I would address this when I was in that situation outside This built my confidence so I was able to succeed when that situation arose again Thank you for helping me - it is an amazing piece of equipment which I m sure would be helpful in many areas
Lorraine - cooking Significant executive deficits, spatial neglect, poor self-awareness following a fall and severe TBI Goal to prepare a main meal for family Script for preparing beouf bourgignon SC movie of cooking New script including SC images Week 1 Week 2 Week 3 Between weeks 3 and 4 Week 4 Baseline trial of task performed, where prompts are only given if risk issues arise; errorless script developed Errorless trial conducted and recorded using SenseCam Trial using just the errorless script occurs SenseCam movie of errorless trial viewed once each day, and a cognitive session used to help Lorraine identify images to add to the script Trial using script with SenseCam images occurs
Frequency Lorraine - outcome 9 8 7 Baseline needed verbal prompts and supervision 6 5 4 3 2 1 0 1 2 3V 3W 3D 3P 4 Independent Rating Baseline Independent Rating With Script Independent Rating With SC Script Little gain from having verbal script 8/12 steps completed independently following SC rehearsal and SC script Present level of ability KEY 1 = independent 2 = needs supervision 3 = needs assistance (Verbal, Written, Demo, Physical) 4 = dependent
Frequency Lorraine - outcome 9 8 7 Baseline needed verbal prompts and supervision 6 5 4 3 2 1 0 1 2 3V 3W 3D 3P 4 Independent Rating Baseline Independent Rating With Script Independent Rating With SC Script Little gain from having verbal script 8/12 steps completed independently following SC rehearsal and SC script Present level of ability KEY 1 = independent; 2 = needs supervision; 3 = needs assistance (Verbal, Written, Demo, Physical) 4 = dependent
Frequency Lorraine - outcome 9 8 7 Baseline needed verbal prompts and supervision 6 5 4 3 2 1 0 1 2 3V 3W 3D 3P 4 Independent Rating Baseline Independent Rating With Script Independent Rating With SC Script Little gain from having verbal script 8/12 steps completed independently following SC rehearsal and SC script Present level of ability KEY 1 = independent; 2 = needs supervision; 3 = needs assistance (Verbal, Written, Demo, Physical) 4 = dependent
Allan benefitting from CBT Anxiety disorder, memory and executive deficits following severe Traumatic Brain Injury Does SenseCam Help with retrieval of emotional content? Enhance potential to benefit from psychological therapy? Contribute to long term wellbeing? Brindley, Bateman and Gracey (2011) Memory,19(7), 745-757 SenseCam special issue Brindley, Harris, Head and Gracey (in prep)
Results SenseCam-supported retrieval is superior to ATR diary or no strategy in terms of detail recalled
Results Content of SenseCam-supported recollections includes a greater reference to internal states, such as thoughts and feelings than ATR or no strategy
Long term outcomes MEASURE SUBSCALE PHASE baseline time 1 baseline t 2 baseline t 3 Post Thera py 3m follow up 9m follow up RCI Post therapy RCI 9m f.u. Beck Anxiety 16 (mod) 20 (mod) 15 (mild) 5 * (min) 2 (min) 2 * (min) Beck 23 (mod) 27 (mod) 24 13 * 8 12 * Depression (mod) (mild) (min) (mild) Robson Self- 90 149 126 156** 158* 164** Concept Q Mobility Inventory for Agoraphobia Avoidance Alone Avoidance Accompanied 4.00 4.58 4.27 2.81 2.96 3.27 2.37 2.40 1.96 1.11** 0.96** 1** Panic 3 3 3 0.1 0.1 0** Frequency Panic Intensity 3 2 3 0.1 0.1 0** -3.5* -4.37* -4.16* -4.52* Mayo-Portland Adaptability Inventory 4 Total Score 50 55 53 50 46* -0.53-1.35* Ability 55 55 53 49** 41** Adjustment 50 58 56 51 49** Participation 49 49 49 45** 46**
Goal Management Training Goal Management Training (GMT) Levine et al, 2000 single case Levine et al 2011 RCT: GMT promotes a mindful approach to complex real-life tasks that pose problems for patients with executive functioning deficits, with a main goal of periodically stopping ongoing behavior to monitor and adjust goals
Generalisation of GMT Executive problems challenge implementing strategies Lack of evidence of carry over into day-to-day life Gracey, Manly, Greenfield, Bateman, Malley, Evans and Wilson RCT of GMT plus random STOP text alerts Cuberos-Urbano, Caracuel, Valls-Serrano, Garcia- Mochon, Gracey and Verdejo-Garcia (in prep) pilot trial of GMT group enhanced with SenseCam movies
DEX (informant) Pre Group mean (SD) GMT + SenseCam Post Group mean (SD) p Pre Group mean (SD) GMT Post Group mean (SD) Inhibition 13.88 (4.79) 9.88 (3.72) 0.079 15.13 (5.79) 13.88 (5.67) 0.563 Intentionality 10.88 (5.36) 8.38 (5.15) 0.021* 12 (3.93) 10.88 (4.67) 0.573 Executive Memory 6.13 (2.1) 3.88 (2.7) 0.062 5.5 (2.33) 5.88 (4.79) 0.831 Positive affect 6.75 (2.66) 4.75 (2.55) 0.01** 8 (2.56) 7.13 (2.75) 0.406 Negative affect 4.38 (2) 3.63 (1.85) 0.111 5.13 (2.17) 4.5 (2.2) 0.329 QoLIBRI Cognition 21.88 (2.99) 24.00 (3.89) 0.271 20.25 (6.67) 21.75 (5.92) 0.080 Self 23.25 (2.96) 24.38 (4.75) 0.416 20.88 (5.17) 22.50 (5.63) 0.142 Daily life and 22.63 (3.38) 25.25 (2.92) 0.015* 18.63 (5.21) 21.38 (4.34) 0.080 autonomy Social 20.63 (3.07) 21.63 (3.46) 0.506 21.63 (5.53) 21.75 (5.70) 0.934 relationships Emotions 12.75 (5.92) 13.63 (5.81) 0.443 13.13 (6.06) 13.13 (4.42) 1.00 Physical problems 11.75 (2.97) 14.25 (3.49) 0.129 13.63 (5.15) 14.88 (4.02) 0.250 Total score 113 (14.35) 123.25 (12.95) 0.032* 108.13 (26.69) 115.38 (23.74) 0.038* Cuberos-Urbano, Caracuel, Valls-Serrano, Garcia-Mochon, Gracey and Verdejo-Garcia (in prep) Preliminary results of a pilot study incorporating lifelog technology into executive function rehabilitation for enhanced transfer of selfregulation skills to everyday life p
Enhancing GMT with SenseCam Using SenseCam movies as the material to discuss in the group may be more meaningful enhance problem solving skills help influence future behaviour
Autobiographical memory and therapy Store of experiences that provide sense of self and continuity over time: mental time travel A particular self is activated in a situation: helps guide us and selfregulate Provides ability to think about a future situation Autobiographical memory Store of experiences that provide information about us, others and the world around us Store containing our experiences, feelings, thoughts in different contexts AM s feature in models of executive function Prompting use of AM might enhance problem solving after ABI Recalling an AM is emotional, not just information In CBT change requires recall of info and emotions
Summary Range of applications in rehabilitation where memory is not the main focus Potential to provide mnemonic enhancement of rehab or therapy Variety of ways in which rehab service users make use of SenseCam Memory single images? Mood movie? Generally viewed as very positive providing security, confidence and ownership of own experiences
THANKS! fergus.gracey@ozc.nhs.uk