Psychologists at Birmingham are giving fresh hope to people suffering from cognitive impairment.
Stuart Cater is making a cup of tea: black with sugar. The 55-year-old machine setter from Worcestershire puts a teabag and two sugar lumps into a mug and switches on the kettle. The only problem is – he’s forgotten to add water.
A cue flashes up on the screen in front of him. ‘Please add water to the kettle,’ it says; showing someone carrying out the action. Stuart hesitates; then follows the instruction. With water safely in the kettle, he clicks the ‘on’ button. But then he immediately picks up the appliance and pours the un-boiled water into the mug.
Stuart suffered a serious stroke 16 months earlier, leaving him not only paralysed down his left side, but also with a mental impairment called Apraxia and Action Disorganisation Syndrome (AADS), which makes it difficult for him to perform basic activities with ordered sequences, such as making tea or coffee.
Stuart and his wife Gill are sitting in a kitchen at the University’s School of Psychology, which is fitted with a range of units, appliances and utensils as well as a bank of computers.
This is the hub of a unique, Birmingham-led scientific project called CogWatch that is being conducted jointly by psychologists and engineers, spanning several European countries and involving a range of organisations.
The aim is to help stroke survivors withneurological difficulties relearn how tocarry out everyday tasks such as brushingtheir teeth and making a hot drink.
Each year, more than 150,000 people in the UK suffer a stroke, which is caused when the blood supply to part of the brain is disrupted. Physical paralysis is the most observable symptom – and on which rehabilitation is focused – but a recent study conducted at the University of Birmingham found that 68 per cent of patients are left with AADS.
It means that without ongoing, home-based help tailored to their needs, these stroke survivors are unable to live independently.
CogWatch, headed by Professor Alan Wing of the School of Psychology, is a four-year, €5 million-funded EU FP7 project being conducted in Birmingham, Munich and Madrid. Although it comes to an end next February, researchers hope to secure further funding to carry it on.
Trials are currently underway at West Park Rehabilitation Hospital in Wolverhampton and in patients’ homes. So far, the results are promising, says Dr Pia Rotshtein from the School of Psychology’s Behavioural Brain Sciences Centre, who is one of the lead researchers.
The project centres on the development of a personalised system that attaches sensors – accelerometers, gyroscopes and force-sensitive resistors – to objects like cutlery, a mug or a kettle, which monitor orientation, motion and grip strength. A central processing system silently tracks patients’ actions by wirelessly collecting data from the objects. If a patient makes a mistake – forgetting to boil the water, for example, or going about the task’s actions in the wrong order – the system will alert them via wrist watches that vibrate (hence the name CogWatch). The system will also provide prompts, which might be relevant images on a display screen, audible sound such as a beep or a spoken instruction.
‘If the patient really doesn’t have a clue, they are given a cue before they perform an action,’ explains Pia. ‘This could be a video or a photograph showing someone doing the action, or a verbal or written description. The clues provided are tailored to the individual’s condition, as AADS patients often have problems with verbal instructions, while others have problems with vision.
‘When we asked one patient to make a cup of tea, he kept putting both tea and coffee into a mug. Another patient looked at the teabag, didn’t know what to do with it, and started chewing it; others tried to put the teabag in the kettle. There are a host of problems that come with loss of knowledge of what you do with an object and how to sequence the activity.’
The idea is that by using the system, patients will gradually re-master hitherto automatic tasks.
While psychologists studied how ‘normal' people made tea and compared them to AADS sufferers’ attempts, researchers at the University’s School of Electronic, Electrical and Computer Engineering (EECE) – which has longstanding expertise in automatic speech recognition and language processing – developed the interactive technology.
As well as being technically difficult, the project has thrown up cultural challenges. For instance, the British way of making a cup of tea isn’t the Continental way.
‘For British people, making a cup of tea is ingrained in their behaviour, but patients in Munich find it more challenging because it’s not so ingrained,’ points out Pia. ‘On the other hand, German patients are much better at filing documents than British patients!’
CogWatch is also bringing together academia and industry: Birmingham’s partners are Technische Universität München in Germany, Universidad Politecnica de Madrid in Spain, Stroke Association, Headwise, BMT Group and RGB Medical Devices.
‘This is a huge collaborative project,’ explains Pia. ‘The bulk of the work is being done here, but there is lots of work being done outside Birmingham.
‘The system is still being developed, but from the trials we’ve done so far, it definitely works. For instance, the patient who kept putting coffee and tea into his mug tried out the system and after being online-guided through the correct sequence five times stopped putting coffee into the mug.
‘It may seem like a small thing, but if someone can suddenly make a hot drink on their own, it can feel like a big step forward and give them the confidence to attempt to do other activities. The more they can do for themselves, the more likely it is that they can live independently.’
Since returning home from hospital, Stuart Cater has been reliant on wife Gill for all his needs, so regaining even a little independence would improve both their lives.
‘I’ve not yet tried to make a cup of tea at home – I don’t think I’d be safe!’ he chuckles, ‘I’m happy to take part in CogWatch because I think all experiments are worth doing. I feel like I’m doing something worthwhile.’
Ros Dodd