Dr Alinda Gillott, Consultant Clinical Psychologist, Intellectual and Developmental Disabilities Service, Nottinghamshire Healthcare NHS Foundation Trust and Dr Michael Craven, Senior Research Fellow, University of Nottingham & NIHR MindTech Healthcare Technology Co-operative Interactive Technologies and Games (ITAG) Conference 2015 Health, Disability and EducationDates: Thursday 22 October 2015 - Friday 23 October 2015 Location: The Council House, NG1 2DT

1. ITAG Community Forum
Technologies in
Mental Health and Dementia
Michael Craven, NIHR MindTech HTC
& University of Nottingham
Alinda Gillott, Nottinghamshire Healthcare NHS FT
www.mindtech.org.uk @NIHR_MindTech

2. • Introduction to MindTech – Mike
• Using technology in an NHS ADHD clinic –
Alinda
• Dementia – Mike again
2
Contents

3. • Aim to be a catalyst for
development of new
technologies
• Technology evaluation
• Focusing on areas of high
unmet clinical need
• Working with NHS,
service users, academia
& industry
• MindTech is based in the
Institute of Mental Health,
UoN Jubilee Campus
3
NIHR Healthcare
Technology Co-operatives
Nottingham MindTech: Mental
Health & Dementia
Sheffield: Devices for Dignity
Cambridge: Brain Injury
Bart’s: Gastrointestinal
Disease
Guy’s: Cardiovascular Disease
Leeds: Colorectal Therapies
Bradford: Wound Care
Birmingham: Trauma
Management

4. 4
MindTech Partnerships

5. • Online peer support – evaluation of
video/live therapy
• Mobile apps for mental health – safety,
effectiveness & how should the NHS use
them?
• Other digital technologies, including Virtual
Reality
• Some medical devices e.g. cranial stimulation
• Emotion/affect detection and medication
response prediction using facial cues
• Public health awareness raising e.g. ADHD
(presented at ITAG 2014)
5
Areas of interest

6. • Small NHS clinic for adults with ADHD
• Common neurodevelopmental condition
• Symptoms of inattention & distractibility,
hyperactivity & impulsivity; executive
dysfunction
• Prevalence around 2% general adult
population
• Lifelong for the majority
• Pervasive; impacts on daily life
6
Using technology in the NHS setting:
Adult ADHD clinic, Nottingham

7. • Text appointment reminders (e.g. Flo
telehealth)
• Apps on smartphones
– Reminder alarms to take medication
– Electronic diaries & ‘to do’ lists (e.g.
Evernote, Remember the Milk)
– Timers
• Audio recording (e.g. for lectures)
• Voice recognition software (e.g.
Dragon)
7
Current uses of
technology in ADHD

8. • Appeals to the patient group (visual,
interactive; use technology
everyday)
• Measuring ADHD symptoms as part
of diagnostic assessment
• Symptom monitoring during
treatment
• Raising public awareness to reduce
stigma
• Future potential in other aspects of
assessment & treatment
8
Potential for utilising
technology in the clinic

9. • Traditionally utilise paper & pencil
neuropsychological tests
• Laborious to administer, score &
interpret
• Computerised tests of sustained
attention widely available (e.g.
continuous performance test; CPT)
• Trial of QbTest in our clinic (AQUA trial
- ongoing)
• QbTest has added component of
movement detection in addition to
CPT
9
Measuring ADHD symptoms
in the clinic: QbTest

10. • Potential value in a clinic setting:
– Objective measure of symptoms
– Instantaneous analysis (saves time in manual scoring &
second clinic appointment to feedback)
– Retesting can be used to measure treatment progress
• Potential barriers:
– Cost of purchase
– Not directly linked to patient data systems
– Not designed as stand-alone test (so still need to assess as
usual)
10
QbTest benefits & barriers

11. CPT implemented on a smartphone
• Objective measure of attention, impulsivity
and activity
• Capture of movement data from phone
sensors during the test
• Early stage of development
Objective
• Establish whether a mobile application
combining CPT with a physical activity
measure could be appropriate for monitoring
symptoms in a clinical population
• Validation
• User acceptance
11
SnappyApp – potential for
remote assessment on a smart
phone?

12. • Potential value in a clinic setting:
– Objective measure of symptoms
– Remote assessment & monitoring
– Could send in the data ahead of appointment (saves clinic time)
• Potential barriers:
– Unable to control the test setting & user (is it really the patient?)
– Security of data transfer to clinic
– Cost of development & maintenance
– Clinician time to review (not a patient ‘contact’)
12
SnappyApp benefits &
barriers

13. • Raising awareness (e.g. Attention Grabber, for Adult ADHD)
• Information/ psychoeducation (e.g. ‘Head Meds’)
• Strategies/ self-help (e.g. ‘My Journey’ EIIP app)
• Broader symptom/impairment rating & monitoring
• Games – SnappyApp fruit & Awkward Owls
• Advantages:
– Patients like ‘NHS endorsed’ products
– Increase patient engagement
– Collect data ahead of clinic appointments
– Reduce paper form filling
– Reduce amount of clinical time?
• Barriers
– NHS IT, cost, data security worries, could add to clinician time?
– Patient worry it may mean fewer face-to-face appointments
13
Newer digital technology -
potential

14. Some areas of need
• encouraging daytime activity
• maintaining hobbies, interests, exercise
• company
• continence
• personal care
• mood
14
Dementia and technology

15. • 1st generation telecare: alarms, pull cords
• 2nd generation: memory aids, other forms of
telecare
• 3rd generation: communication, smartphones, apps
• technology that people with dementia use
themselves (by them) satnav, mobile phones
• that which is used with them electronic calendars,
reminiscence
• that is used for them sensors, alarms, hoists
after Gibson et al (2014) Dementia, doi: 10.1177/1471301214532643
15
Categories of Assistive
Technologies

16. 16
Classifications (continued)
• Applications where the
technology is the thing
e.g. iPads, robots
or
• Applications supported by
technology, where the
tech is invisible or in the
background
e.g. bed sensor
Also includes services,
including integration of health
and other records
• Technologies specifically
designed for people with
cognitive impairment
e.g medication
reminder
or
• Everyday technologies
which lend themselves
well to people with
cognitive difficulties
e.g. voice recorder

17. 17
Examples 1
Memory technologies
• reminder messages
• clocks and calendars
• medication aids
• locator devices (for ‘lost’ objects)
• aids for reminiscence and leisure

18. 18
Examples 2
Telecare technologies
• ‘Smart home’ sensors
– Floods
– Extreme temperature
– Gas
• Location
– Absence from
bed/chair
– Getting up in the night
– Leaving the home
• Falls
• Physiological sensors

19. 19
Examples 3
Communications technology
• Video links
• Home hubs
• Phone/tablet apps
• Telepresence ‘Robots’

20. 20
Examples 4
Company and ‘pets’
• Paro seal
• JustoCats
Altered or virtual worlds
• Hogeweyk – dementia
village in Holland
• AVED (Applied Virtual
Environment for
Dementia Care)
http://hogeweyk.dementiavillage.com/en/

21. 21
Areas for development
• TV / Smart TVs
- Post reminders, Skype/remote calling
- Make personal DVDs, run favourite films
- Simplified remote controls
- Observable behaviours incl. dozing, watching black screen
• Music & arts
- Calming soundtracks
- Group activities in care homes
-Shared reading
Most require close supervision
• Sensors for early diagnosis?
- Detect changes in day-to-day activities
e.g. use of kitchen; going out; food choice
acceptability to older person?
• Intelligent lighting to support daily living
- Sequencing of lights to guide tasks such as shaving, cleaning
teeth etc.

22. 22
Aspirations
• Critique of conventional Assistive
Technologies and its intended
purpose
• More focus on Quality-of-life -
‘living well with dementia’ – not
just about safety and containment
• How can technology support
Autonomy, independence and self-
actualisation?
• Improve access to AT appropriate
technology
• Equity of access

23. 23
Some dementia tech-related
projects at Nottingham
• CASA: Connecting Assistive Solutions to Aspirations (funded by Innovate UK SBRI)
• KuPA: Knowledge-based Person-centred Activity service with SINTEF-
Noen AS (funded by Norwegian Research Council)
• Mindful design: EU RISE project (funded by EU Horizon 2020)
• Project details: http://www.mindtech.org.uk
Plus
• Locally running online information resources
– IDEA http://idea.nottingham.ac.uk/
– ATdementia http://www.atdementia.org.uk/
• Centre for Dementia (at Institute for Mental Health)
• East Midlands Research into Ageing Network
– EMRAN http://www.nottingham.ac.uk/emran

24. 24
MindTech symposium 2015
Harnessing the Digital Revolution
Thursday 3rd December 2015
Royal College of Physicians, London
Speakers include:
• Dr Geraldine Strathdee - NHS England
• Alexia Tonnel - NICE
• Eve Critchley - MIND
• Professor John Geddes - The University of Oxford
www.mindtech.org.uk @NIHR_MindTech

25. Thank you
Any questions?
www.mindtech.org.uk @NIHR_MindTech