Misconceptions about designing technology for dementia – it’s simple or it’s impossible!

This article has been reblogged with the permission of Designability – original article available here

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Hazel Boyd
, User Interface Engineer at Designability, specialises in designing technology with and for people with dementia. She wants to tackle some myths that are commonly assumed when designing for dementia.


I often hear the same contradiction from people about designing with people with dementia in mind. Some say:

“Your simple, standalone products must have been easy to design”

Whereas some tell us:

“It must be really hard to design for people with dementia”

These views are understandable when they come from people who don’t get to see the design process in action, or from those who have no direct contact with people who have dementia. Part of our role is to educate and inform people to help change those views.  There are quite a few misconceptions that we commonly hear, the most common being:

Myth #1: You can’t ask people with dementia what they think because they don’t know and they can’t tell you

This will be a shocking statement to those who work with people who have dementia. Many people with the condition are still actively enjoying life, using iPads or even writing their own blogs. However, many think that people with dementia are no longer able to give their opinions in a meaningful way because of their illness. But we know that dementia is progressive and therefore does not affect everyone significantly to start with. Those who have always been interested in design or volunteering their views may still be willing and able to continue to do that for some time. There are appropriate ways to speak with those with more advanced dementia to enable them to share their views, opinions and ideas. If product designers do not engage with their customers and product users, they are missing out on a wealth of valuable information.

Myth #2: People are all individuals so you can’t possibly design something that works for everyone with dementia

It’s true that many aspects of a person with dementia are not governed by their dementia. A group of people with dementia will have different ages, backgrounds, personalities, interests and other things.  Similarly, different types of dementia manifest in different ways and progress differently in each person. However, our research has shown that there are some common aspects of design which can work well for many people with dementia. The most common aspect that we deal with is the reduction in short-term memory, which requires us to base our products on familiar and/or obvious ideas. Designing to support poor short-term memory works regardless of people’s differences. In addition, by designing products that work for a large number of people, we are better able to reduce product costs, and help more  people.

Myth #3: That looks simple, so it will be easy to use

It is a common assumption that simple is the same as easy. In our design work it has become quickly apparent that they are not the same at all. Simple design might have few features or dials and look very easy to use. Indeed, for people who do not have dementia, they might be easy. However, many of us take for granted how we adapt when using products, and how well we can compensate for any confusion or lack of information as we find our way around something new. Reduced short-term memory limits this ability to adapt, meaning that simple may not be enough. Straightforward controls which are familiar, or described clearly at the point of use, are essential. If an object is not recognised (the new washing machine or a different TV remote control) it may never get used at all.

Myth #4: Intuitive design is no good, my Dad can’t use a smartphone and that’s intuitive

There seems to be a widely held view that some leading smartphones (for example) are intuitive to use. However, what they actually do is work smoothly, are easy to learn and match what the user wants to do. This learning is something that becomes tougher for someone with short-term memory problems. In our designs, we work hard to make sure that no learning is required and that they can always be used “as if for the first time”. We know that people with early stage dementia, or people with types of dementia which do not initially result in memory loss, can still learn new skills. However, we focus on those without the capacity to learn for our target group as their need is greatest.

These are not the only misconceptions that we come across in our design work. However busting these myths does help designers, carers and users understand why some products work well for those living with dementia and some do not.

What other myths are you keen to challenge in this area? Let us know in the comments.

Hazel was actively involved in the development of our Day Clock, One Button Radio and Simple Music Player and is currently engaged in ongoing research and development in the field of assistive technologies for those living with dementia.

Experience: Assistive Technology and My World

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Elle* is a wheelchair user and technology lover who has agreed to be a pioneer for CHIRON. She speaks to Sinéad Nolan about the future of assistive technology…

A 75-year-old grandmother with two sons and four grandchildren, Elle is an unlikely candidate for a robotics enthusiast. Yet as a user of an electric wheelchair, and a lover of sci-fi, Elle has plenty of experience of how assistive technology can help a person, as well as a keen interest in its place in society.

We had arranged to meet last week in a spacious, kitsch café in London with quirky décor – a decision which I later realise fully reflected Elle’s personality.
Once we were both at the table, falafel in hand, she opened up candidly about what brought her to the situation of being in a wheelchair, and her feelings on technology and society as a whole.

‘I had a bad traffic accident on a bus and unfortunately I had radiotherapy for cancer which didn’t help. The muscles in my leg don’t work,’ she explained.  ‘I also lost feeling in both my hands. I didn’t realise how bad it was until one day I picked up a hot saucepan and I couldn’t feel it – I burned my hand. After having an accident and becoming disabled, the things you used to take for granted change.’

Elle’s story is not entirely uncommon. According to the Disabled Living Foundation, there are over 10 million disabled people in Britain, part of which makes up 19% of the working population. Many of these people will not have always had problems but things can change dramatically overnight. The reality is that many of us may need assistive technology at some point in our lives either as we age, or because of accidents or illness. However, as Elle noted, even with assistive technology getting around without full mobility can be a little more difficult.

‘If I want to go and stay in a hotel I have to ring ahead and check that its possible for me to get to the room. I need to think about things like what side of the bed I get in. You have to belt and braces all the time. For everything. Even to come here today – everything.’

Elle mentioned that she owned an I, Robot head from the 2004 movie starring Will Smith, as well as a virtual reality headset, so I was interested to know more about her relationship with technology.

‘It must be part of your life,’ she replied. ‘My relationship with technology is that it’s like a friend. I don’t abuse it. A lot of people may say: “I couldn’t do it” about technology but if you buy a washing machine, that’s a computer. Or a microwave, they are all chips.’

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Assistive technology can be defined as “any device or system that allows an individual to perform a task that they would otherwise be unable to do, or increases the ease and safety with which the task can be performed.” However, occasionally this technology can be perceived with suspicion by many who fear a dystopian world with robots replacing human carers.

‘People say with technology it means you won’t go anywhere or do anything but I believe you can do both. I collect books, I have a kindle. My friend has a false eye with a video recorder in it! He’s got a camera in his eye, he can switch it on and see the recording of where he is. I think if you’ve got a space, fill it. What would you do with a glass eye anyway – impress your friends? Who are we going to fit in with – that old black woman, that young white man?’

‘When you come down to it everything is a robot it’s just a different shape,’ she continued.
‘For example, the new washing machine, the Samsung, is a real working, square, white robot. It actually can work out how much powder you need. It will tell you what temperature to use and if you’ve forgot something there is a door you can open. That is technology and to me, that is a robot. It helps you with everyday tasks.’

As a user of an electric wheelchair, Elle has plenty of experience of how assistive technology can help a person. I ask what specifically the best things might be to help a user.

‘I think you don’t necessarily need a computer to be a friend, to say “Hello how are you?” Instead it can be very useful for making beds, pulling duvets over, checking doors, checking lights, to circumvent dangerous things, doing up buttons and zips, just little things that if you weren’t disabled you wouldn’t realise were difficult.’

Overall, Elle is philosophical about society and her place in it as an assistive technology user. What I see over our lunch is that she remained open-minded and strong in the midst of what some people can find a mire of cultural stereotypes.

‘As I have gotten older, and now I am disabled as it were, you do sometimes get treated as a toddler – it’s almost a pat on the head. It’s annoying. Because all you are is older. We live in a culture of division as well. I have a friend and he says (about transport and getting around), “Oh it must be terrible, I don’t know how you do it.”

‘I say, no it’s not, I love it! It’s part of your life – that’s it or you would just stay indoors all day.’
‘Am I supposed to apologise for being alive?’ she adds with a laugh. ‘I’m damned if I’m going to do that!’

‘Robots Helping People’

An event at IET – Speaker: Professor Yiannis Demiris, posted by Sinéad Nolan.

Working on the CHIRON project, it is always helpful to attend events to see what other people are up to in the assistive technology world. With that in mind, I went to see Professor Yiannis Demiris speak at the ‘Robots Helping People’ event at the Institute of Engineering and Technology last week (11th May 2016).

Is this the future?

While many people hear the word ‘robotics in care’ and jump to conclusions based around the potential for worst case scenarios often imagined in the media (Channel 4’s Humans springs to mind), the reality at this event seemed rather different. Instead of a dystopian hell which featured robots instead of human carers, it was based more around assistive technology or assistive robotics becoming a supplement for certain basic services a carer might provide.

“I started the lab in Imperial called personal robotics for a particular reason – I have the vision that robots do not belong in factories,’ said Demiris. “They are robots that try to help us in any way they can. The reason I call them personal robotics is because one of the key issues is that we need personalisation.”

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User needs

As anyone who has undertaken a project knows, things don’t always turn out as we plan them. That is why user engagement absolutely needs to be prioritised before building anything.

In one of Demiris’ most recent projects they tried to build smart wheelchairs for children with disabilities equipped with sensors to help the user navigate a corridor. An interesting thing happened in these studies – what they found was that many got frustrated when the wheelchair was controlled externally.

One of the mistakes, Demiris says, is for the engineer to assume they know what the user wants outright – instead they need to listen to what the user wants, and think about how they build a better way to make this possible.

‘Eventually, we tried to change the behaviour of the wheelchair to match the skills of the kid that was actually driving. These wheelchairs wanted to be able to adapt to the changing profile of the user.”

Instead of controlling the user, the user controlled the wheelchair – and the adaptive system only stepped in when needed (for example, if the child was about to bump into something).

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Adaptive systems

Similarly, some of the robots Demiris designed aimed to observe how you move and tried to modify the trajectories for itself. This manifested in a robotic pair of arms that could carefully and gently help someone put their jacket on (see video here).

From an engineering stance this meant adaptive systems applicable to lots of different domains, whether it was physical cognitive, emotional or artistic.

“They all have the same underlying philosophy of getting some data from the user, building a model and adapting the behaviour to this user.

“We want to build the same technology for every person, and then the application area changes but the underlying technology stays the same. An interactive learning cycle which keeps going constantly with interaction with the user. We don’t use to one type of algorithm, we use lots.”

Challenges

One of the key issues Demiris pointed out, were the challenges in trying to build a robot that could assist people.

“One is personalisation’s – we have to explicitly model the users’ parameters so we have to be able to adjust the behaviour based on these generic internal model – and then I will change the behaviour. It’s not useful to have the same type of behaviour for everyone.

“Prediction is a key point in our work, there is no point when you are building assistive robotics using traditional AI techniques which rely on collecting all your data, doing some sort of classification, then acting.”

Instead, once Demiris and his team have a model, they try to predict what kind of assistance this particular person needs. They personalise the assistance for each individual user and constantly adapt the assistance to different users.

“If you have, for example, something that helps you walk and prevents you from falling down, it’s no use for you to fall down and then to realise, ‘Ah I should have helped!’ For us the key point is actually doing prediction and prediction means collecting all the data trying to run in forward in time, trying to see if there will be some needs later and acting before the person needs the help. “If you act when the person has already fallen down, it’s too late,” he added.

But limitations and challenges aside, Demiris is positive about the future of assistive technology in the care sector.

“The time where we can have a robot help us for a minute has passed, we are going to have robots among us for longer periods of time and they have to get to know us, to serve us better.”