valencia 25-26 march 2003 haifa 13 january 2005 ambient intelligence atn-p lab. 1 ambient...

1Valencia

25-26 March 2003

HAIFA13 January 2005

AMBIENT INTELLIGENCE ATN-P Lab.http://www.ambientintelligence.org

Ambient Intelligence in

Rehabilitation

Francesca Morganti, PhD

Istituto Auxologico Italiano

[email protected]

http://www.ambientintelligence.org http://

www.emergingcommunication.comhttp://www.atnplab.com

2Valencia

25-26 March 2003



Presentation Layout

• How to define disability?

• Types of intervention in disability

• AmI as new assistive tool for disability

• AmI for situaded intervention in rehabilitation

• AmI rehabilitation scenario– Spatial cognition impairment – ANNA, when AmI supports topographical amnesia

rehabilitation

• Final remarks

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Disability

• Disability is not a disease but a “being condition” (ICF-WHO definition)

• Disabled people is temporarily or definitively unable in performing an activity:– in the correct manner and/or…– at a level generally considered ‘normal’ for the human being”

Disability is not an individual characteristic, instead it is a specific situation in which a person is not able to fully cope with everyday contexts

– this limitation could be caused by a particular physical/cognitive impairment of the subject. – but also it may be the result of some external constrain that compromises the full participation in a specific

activity.

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Disability and Rehabilitation• The Disability and Rehabilitation Team at the WHO

estimated the number of people who require rehabilitation services as the 1.5% of the entire world population

This percentage is continously increasing!

• Rehabilitation resources actually avaliable are focusing on the “disease” aspect of disability.

The disease-oriented approach considers disabled subjects as dependent in everyday life situations

Rehabilitative interventions try to recover and support this dependency

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Indipendency

It is needed to stat in considering disabled people like persons with a great potential for independent living.

Disabled people are potentially “new actors” of their everyday life

Rehabilitation have to support them in achieving independence and satisfaction.

However, the involvement in the community life requires accessibility

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Accessibility

• Is the possibility to participate in the physical and social aspect of life.

• Accessibility doesn’t mean only physical affordability

• It involves the complete range of activities in which the subject is involved during his daily cognitive, social and cultural based interacions.

• Unfortunately, the available solutions do not fully match their needs

The evolution of technology may help in improving accessibility.

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Improving accessibility

• Technological artifacts has been developed to compensate for human functional limitations

• Instead of creating an aid, the complexity of these tools improved a “digital divide” between disabled people and the rest of population

In order to be useful

• Technological aids have to be activity-targeted tools in which the user, especially if disabled, is at the centre of the technology focus.

• Computers have to move in the background

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An example

Generally a person is able to write a paper with a pen…

…whereas it is possible that another person is limited in the pen use, but is able to write the same paper using a computer keyboard

none of them is defined as disabled!

What happens f both of them will be in a condition in which the tool, that allows them to write the paper, is not

available in a specific moment?

they will be both disabled in performing the activity!

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Creating an alternative

If technology have to improve the quality of the life of any subject supporting his/her activity and interaction.

Ergonomics have to identify specific guidelines for the development of right tools and services supporting the

activity of any user.

Where there is a specific interaction disability technological tools have to provide alternative affordances in performing the specific disabled activity planning

AmI has a great potential for achieving this goal

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Why AmI supports activity? • Any activity is structured in two intertwined levels

– actions and– operations each characterized by specific goals and conditions

• The situation is the physical, social and cultural space (context) in which the activity is carried out

• The feeling of presence provides to the subject a feedback

about the status of its activity

AmI is the effective and transparent support to the activity of the subject/s through the use of information and communication technologies.

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AmI, activity, rehabilitation

• How AmI could be usefull in rehabilitation?- the role of AmI in rehabilitation is related to its ability to support

action

• Any AmI-based rehabilitative system have to identify:– “effectiveness” (the activity reaches its objective) and – “transparency” (the activity is experienced without

breakdowns)

• AmI assistive tools have not only to compensate but also to expand the activity of users through new forms of human-computer interaction

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Compensatory approach

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AmI as situated intervention

• AmI may offer new and more effective environmentally oriented intervention (it can provide active guidelines/suggestions to the activity of the subject)

• AmI may adapt the complexity of a tool according to the characteristics of the user

• AmI supports the employment of physical objects, surfaces, and spaces as tangible embodiments of digital information

• AmI allows the provision of a feedback to the activity of the subject

Tangible interfaces transform the ambient (e.g., walls, desktops, ceilings, doors, windows) into an active interface between the user and its activity

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ANNA

• 45 years old, teacher

• Stroke injury, topographical disorientation

• Topographical amnesia:

– Impairment in memory of environmental landmarks

– Inability to recall the location of different spatial landmarks.

Actually she has a selective impairment of the ability to find one’s way in new

environments but her deficit is not associated with dementia, acute state of

mental confusion, visuo-perceptual disorders or global amnesia

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Spatial Ability

• Landmark knowledge

• Route maps

• Survey maps

Not progression but combination

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What Anna can do

• To travel “familiar” paths

• To continue her life at home

• To go out of familiar places with a relative or a caregiver

• To continues her teaching activity

Even if Anna’s common life can re-start, sometimes she feels “lost”

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What Anna can’t doCall for an effective help when she feels lost and she’s alone !

• Anna has not the possibility to inform helpers about her position within the city– She doesn’t recognize buildings or significant places – She has not the ability of position herself in relation to a well

known landmark– She is not able in mentally rehearsing a traveled path she has

done

• Anna has not the possibility to use information given by helpers – She doesn’t know how to relate a start place to the direction she

have to follow to reach a target point – If she had a city map she doesn’t to use it

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What Anna needs

• A support to effectively route the surroundings according to her everyday needs

• A ‘strategy’ to cope with the anxiety problems she experiences during the exploration of new environments

• A possibility of creating social relationship with colleagues or friends without experiencing frustration

• A tool able to monitor the entire situation without interfere with Anna’s coices

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How to provide it ?

• Provide Anna with the possibility of effectively operate within the environment

• Improve Anna’s autonomy monitoring her, without significantly changing her habits

• Support Anna’s social re-integration improving her psychological sense of autonomy

• Actively involve Anna’s relatives and caregivers without turning them intrusive or giving them the opportunity of deciding for Anna’s life

• Coordinate clinicians and relatives information about Anna’s

rehabilitation course, creating a highly interactive place for knowledge share

• Psychologically support Anna and her relatives during the rehabilitation process.

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How AmI can provide it ?

• Creating both accessible opportunities for Anna, and provide action affordances that are aware of Anna’s changes during the recovery process

• Sensing her location within the environment, both outdoors and at home, relying on a wide range of sensors such as motion detectors, and other ubiquitous computing infrastructure

• Learning to decode patterns of everyday behaviors, and recognize

signs of distress, disorientation, or confusion, using bio-signals monitoring, voice recognition, and behavior analysis

• Offering help to Anna through not invasive sound or visual cues

• Creating a common knowledge space for health experts and Anna’s relatives

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AmI scenario

• Multilevel around Anna’s life

– Consider different aspects of Anna’s daily interaction with the “known” context such as her home and/or job life

– Manage her goals and needs within the “unknown” part of the city

– Link her with the hospital in order to… – Track the “rehabilitative” course

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AmI for spatial rehabilitation

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Anna’s known space 1

AT HOME

• Anna is able to manage space in her home

• She was not able in remembering the new location of objects

• AmI can help her noticing object locations

• Object alert are costumed on Anna’s residual abilities

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Anna’s known space 2

AT SCHOOL

• She has developed strategies for efficiently explore the building

• The school can be used as example for creating an AmI-based ecological training context

• Embedded sensors might sample Anna’s paths and travel preferences during her more frequent navigations …

• … linking this explorative information with other information AmI might create appropriate aids for navigation in unknown places

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Anna’s unknown space 1 SUPPORTING ANNA’S GOALS

• Landmarks have to be meaningful in order to be useful

• Hierarchy of goals – ANNA’s local goal: reach a target place– ANNA’s general goal: improve indipendency

• AmI have a “database” of Anna’s preferences in exploration

• Spatial cues based on egocentric frame of references

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Anna’s unknown space 2 SUPPORTING ANNA’S FEELINGS

• Sometimes unexpected events could come

• Anna gets lost and she feels so confused (she is not able to ask for help)

• AmI should monitor her physiological state during her exploration

• A significant change in biosensors alerts the system that provides to Anna some support

• Anna has not the explicit feeling of being controlled during her daily activity nevertheless, she can receive a critical help during an awkward situation

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Anna’s rehabilitative space FOR ANNA

• Training in an ecological scenario

• AmI calibrates spatial tasks complexity according to them

FOR THERAPISTS

• AmI allows to monitor Anna’s progresses in rehabilitation

• AmI can collect all the information about Anna into an integrated virtual information space accessible to all professionals

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Final remarks

• Disability is a being condition in which people is unable to perform an activity

• AmI assistive tools can compensate or expand the activity of a disabled subject through new forms of human-computer interaction

• Any rehabilitative AmI system may offer new and more effective environmentally oriented interventions through: – The provision of active guidance (guidelines/suggestions) to the

activity of the subject – The adaptation of the complexity of a tool according to the

characteristics of the user. – The support to the use of other assistive devices – The provision of a feedback to the activity of the subject by

tracking its course.

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References 1• For disability definition:

– International Classification of Functioning, Disability and Health (ICF). Avaliable at http://www3.who.int/icf/

– WHO/Disability and Rehabilitation Team. Report 03.2 – Helsinki 25-28 May 2003. Available at http://www.who.int/ncd/disability

• For spatial cognition:

– Tirassa M., Carassa A., Geminiani G. (2000) In Spatial Cognition. Foundations and Applications, ed. S. ÓNualláin, Benjamins Press, pp. 19-31

– Carassa A., Geminiani G., Morganti F., Varotto D., (2002) In Cognitive Processing – International Quarterly of Cognitive Sciences 3-4, pp.65-81

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References 2• For technology and neuroscience:

– Riva, G. (1998) Virtual reality in neuroscience: a survey. Avaliable at http://www.emergingcommunication.com

– Morganti, F. (2004) Virtual interaction in cognitive neuropsychology. Avaliable at http://www.emergingcommunication.com

• For AmI in Health care:

– Riva, G. Ambient Intelligence in Health Care. Cyberpsychology and Behavior, 6 (2003), 295-300

– Morganti F., Riva G. (2005) Ambient Intelligence for rehabilitation. Avaliable at http://www.emergingcommunication.com

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Thank you for your attention

Francesca Morganti, PhD

Istituto Auxologico Italiano

[email protected]

http://www.ambientintelligence.org http://

www.emergingcommunication.comhttp://www.atnplab.com

valencia 25-26 march 2003 haifa 13 january 2005 ambient intelligence atn-p lab. 1 ambient...

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