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

• Introduction to MindTech – Mike

• Using technology in an NHS ADHD clinic – Alinda

• Dementia – Mike again

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Contents

• 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

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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

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MindTech Partnerships

• 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)

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Areas of interest

• 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

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Using technology in the NHS setting: Adult ADHD clinic, Nottingham

• 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)

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Current uses of technology in ADHD

• 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

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Potential for utilising technology in the clinic

• 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

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Measuring ADHD symptoms in the clinic: QbTest

• 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)

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QbTest benefits & barriers

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

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SnappyApp – potential for remote assessment on a smart

phone?

• 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’)

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SnappyApp benefits & barriers

• 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

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Newer digital technology - potential

Some areas of need

• encouraging daytime activity

• maintaining hobbies, interests, exercise

• company

• continence

• personal care

• mood

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Dementia and technology

• 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

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Categories of Assistive Technologies

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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

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Examples 1

Memory technologies

• reminder messages

• clocks and calendars

• medication aids

• locator devices (for ‘lost’ objects)

• aids for reminiscence and leisure

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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

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Examples 3

Communications technology

• Video links

• Home hubs

• Phone/tablet apps

• Telepresence ‘Robots’

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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/

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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.

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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

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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

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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

Thank you

Any questions?

www.mindtech.org.uk @NIHR_MindTech