SHORT-TERM MEMORY LOSS AND SMARTPHONE APPS GIANLUCA DE LEO PhD MBA COLLEGE OF HEALTH SCIENCESVIRGINIA MODELING ANALYSIS AND SIMULATION CENTER OLD DOMINION UNIVERSITY NORFOLK VA, USA GDELEO@ODU.EDU +1 757 683 6733
Outline Smartphone: a Brief overview of Who am I? disruptive Alzheimers disease technology Smartphone Case study researchsolution to capture Results projectdaily life moments Vision Q&A
Who am I?In Genova, Italy:• BS, Electronic Engineering (1997)• MS, Electronic Engineering (1999) In St. Louis, MO: • PhD, Biomedical Engineering (2003) • Post Doctorate, Public Health Informatics (2005) • MBA (2005)
QuestionHow many of you have heard about:disruptive technology?
Disruptive technologyA disruptive technology or disruptiveinnovation is an innovation that helps create anew market and value network, and eventually goeson to disrupt an existing market and value network(over a few years or decades), displacing an earliertechnology there. 
Disruptive technology Do you think that "early cars" should be considered disruptive technology?Horse-drawn vehicles Early cars
Disruptive technology FORD Model T was a disruptive technology!Horse-drawn vehicles FORD Model T
Disruptive technologyThe hydraulic excavator was a disruptive technology!Cable-operated Hydraulic excavatorexcavator
Smartphones (1999) • NOT yet a disruptive technology • NOT affordable • NOT easy to use
Smartphones: Disruptive technology (2011) Smartphones: • disruptive technology • affordable • easy to use • changing how we: • Communicate • Interact • Play/access music • Take pictures • Access information
My experience with smartphones I Click I Talk: The research driven AAC system for iPhone, iPad and Windows. Perfect for all ages, all communication disabilities and all languages.
Background on Alzheimers • Currently, 5.4 million Americans are affected withSignificance Alzheimers Dementia  • Alzheimers is a neurodegenerative disease causing progressive decline in memory. Science • The disease’s most frequent and recognizable symptom is memory loss associated with recent events  • Three main stages: Mild, Moderate and Severe. • Patients suffer from increasing confusion, disorganized thinking, impaired judgment, trouble Stages and in expressing themselves, and disorientation. Effects • Dependence on caregivers increases steadily to the point of becoming burden, affecting the quality of life of patients and caregivers  • No permanent solution, but cuing patients about the Treatment past events can reduce the rate of decline in memory 
Background on Alzheimers The capacity to remember recent events is linked to autobiographical memory, human memory responsible for archiving and recollection of specific personal experiences  Autobiographical memory allows people to have a coherent tale of their personal experiences , a sense of self , and a ‘‘life history’’ to talk about with other people  Loss of autobiographical memory causes confusion and frustration in patients with AD, and their caregivers have to step in to assist in the memory recall process
SenseCam The SenseCam is a wearable digital camera that is designed to take photographs while it is being worn, without any user interaction This specialized camera captures a picture every 30 seconds. These pictures are uploaded to a computer by a nurse and combined into a movie. The movie is then shown to the subject. The movie serves as a recap of the subject’s dayNow a product byVicon Motion Systems Inc http://research.microsoft.com/en-http://viconrevue.com us/umcambridge/projects/sensecam/introduction.htm$500
My personal experience with Alzheimers My grandmother (on my mother’s side) 1917 – 2008 • Healthy individual • Her memory (recent events) started declining in 1990 • Degenerated to no communication in 2006 • Increase burden on caregivers (her 3 daughters)
Smartphone• Samsung Blackjack Flat surface less blurred images Windows based• iPhone does not allow taking pictureautomaticallyTest idea: the smartphone wasprogrammed to capture an imageevery 5 minutes by using the in-builtcamera
Smartphone solution to capture daily life momentsThe subject carries the smartphone during the day, by way of the supplied lanyard, for 4 weeks The smart phone automatically takes pictures every 5 minutes during the day (8:00 a.m. to 8:00 p.m.) and uploads them to a secure server during the night (at 2:00 a.m.)The images are automatically retrieved, date-stamped, combined into a slideshow, and burned onto a DVD DVDs containing the final slideshows are mailed to the patient every week along with a satisfaction survey and a memory recall testThe subject/caregiver uses a pre-stamped envelope to return the completed test and survey to the investigator
Subject 80-year-old, His caregiverright-handed, Holds a was his wife,married male master’s age 73, also a Familiar with in stage 4 of degree and is college the use of cell the FAST a retired graduate. phones scale (Mild military They had Alzheimer’s) officer been married  for 54 years Patient at theHampton Roads Neurophysiology Clinic, located in Virginia Beach, Virginia
MeasurementsRepeatable Battery for the Assessmentof Neuropsychological Status (RBANS) (before and after the interventions)  Subject Satisfaction Survey (once a week) Recent events memory recall test (once a week)
MethodsSubject Satisfaction Survey (once a week, Likert scale 1 to 5) I feel comfortable wearing the smart phone around my neck The smart phone is invasive Seeing images from the slideshow brings back the memories of recent events I feel less anxious knowing that the smart phone is recording what I am doing I feel more relaxed in social situations because the slideshow will show me who I meet Sharing past experiences through the slideshow with my family is a pleasure Watching the slideshow helps me deal with daily tasks better Recalling events with the help of the slideshow agitates me Watching the slideshow with my family is boring The slideshow has been a useful tool for my family The slideshow has been a useful memory aid for me The smart phone is easy to use
MethodsRecent events memory recall test (once a week, yes or no)
ResultsSubject Satisfaction Survey The subject did not have any problem wearing the device The subject considered the slideshow a useful tool for helping to live with persistent memory loss.
Results It is possible to capture ones real life experiences without any involvement of the subjects. Pictures collected do represent an ensemble of the important events occurred in the past. Pictures from smart phones may indeed be used as an assistive device in the recall of recent events.
Limitations/problems Case study with only one subject Battery did not last the entire day Subject forgot to wear the device (one day) Smartcard was accidently disconnected (no pictures for a week) Caregivers involvement is needed
Vision No more DVD. Images will be made available on the web and subjects will look at them using tablets Surveys available on-line GPS capability The smart phone (camera, data connection, and operating system) will be miniaturized and made available in the form of jewelry or a tie pin
Vision EMERGENCY HOSPITAL PRIMARY PREVENTIVE WELLNESS CARE CARE CARE CAREACUTEPATIENTS TRADITIONAL BIOMEDICALCHRONIC MARKET SEGMENTSPATIENTSCITIZEN EMERGING MARKET SEGMENTSCONSUMER NEXT GENERATION MARKET SEGMENTS
Research partners Eleonora Brivio, MS Old Dominion University Scott W. Sautter, PhD, FACPN Hampton Roads Neuropsychology Virginia Beach VA Project funded by: The Virginia Center on Aging, Virginia Commonwealth University, Richmond, VA (2008)
References Bower, Joseph L. & Christensen, Clayton M. (1995). "Disruptive Technologies: Catchingthe Wave" Harvard Business Review, January–February 1995 Alzheimer’s Association. (2011). 2011 Alzheimer’s disease facts and figures. Retrievedfrom http://www.alz.org/downloads/Facts_Figures_2011.pdf Lee, M. L., & Dey, A. K. (2007). Providing good memory cues for people with episodicmemory impairment. In Proceedings of the 9th International ACM SIG ACCESS Conferenceon Computers and Accessibility (pp. 131–138). New York, NY: ACM. Barclay, C. R. (1986). Schematization of autobiographical memory. In D. C. Rubin (Ed.),Autobiographical memory (pp. 82–89). Cambridge, England: Cambridge University Press. Brewer, W. F. (1986). What is autobiographical memory? In D. C. Rubin (Ed.),Autobiographical memory (pp. 25–49). Cambridge, England: Cambridge University Press. Harley, K., & Reese, E. (1999). Origins of autobiographical memory. DevelopmentalPsychology, 35, 1338–1348 Sclan, S. G., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’sdisease: Reliability, validity, and ordinality. International Psychogeriatrics, 4(3), 55–69 Randolph, C. (1998). Repeatable Battery for the Assessment of Neuro- psychologicalStatus (RBANS). San Antonio, TX: The Psychologi- cal Corporation.
References (who am I?) De Leo G, Ponder M, Molet T, Fato M, Thalmann D, Thalmann N, Bermano F,Beltrame F. A Virtual Reality System for the Training of Volunteers Involved inHealth Emergency Situations. CyberPsycology & Behaviour, 2003; 6(3): 267-274. De Leo G, Krishna S, Boren S, Fato M, Porro I, Balas E A. Web and ComputerTelephone-Based Diabetes Education: Lessons Learnt from the Development andUse of a Call Center. J Med Syst , 2005; 29(4):343-355. Boren SA, De Leo G, Chanetsa FF, Donaldson JF, Krishna S, Balas EA.Evaluation of a Diabetes Education Call Center Intervention. TelemedicineJournal and E-Health. 2006; 12(4):457-465. Kott K, Lesher K, De Leo G. Combining a Virtual Reality System withTreadmill Training for Children with Cerebral Palsy. Journal of CyberTherapy &Rehabilitation. 2009; 2(1): 35-42. De Leo G, Gonzales C, Battagiri P, Leroy G. A Smart-Phone Application and aCompanion Website for the Improvement of the Communication Skills of Childrenwith Autism: Clinical Rationale, Technical Development and Preliminary Results,J Med Syst. 2011; 35:703-711.