Temporo-spacial Prompting for Persons with Cognitive Impairment Using Smart Wrist-worn Interface

INTRODUCTION In this editorial, we report on the development of a smartwatch designed to enhance the Smart Home at the Department of Veterans Affairs (VA) hospital in Tampa, a project that uses advanced tracking technology to help Veteran patients with traumatic brain injury (TBI) independently plan, organize, and complete everyday activities [1]. The literature is replete with examples of proposed technologies designed to influence or control behavior, the most recent incarnation being "persuasive technologies" [2-3]. While handheld smartphones have been the pervasive device that readers are most likely to have experience with, new devices targeted at the consumer market now include Google Glass and Samsung's Galaxy Gear smartwatch. Both devices attempt to make the interaction with wireless computing infrastructures a ubiquitous experience. Similarly, many new persuasive applications have been developed to run on common devices such as smartphones, PDAs, and standard computer systems. These applications are often designed to prompt for desired behaviors contingent on time of day to provide basic reminder functions. Very few of these applications use global positioning system (GPS) to derive location and far fewer still are based on precise indoor location [4]. A handful of technologies combine time of day with coarse indoor location to provide targeted prompts to individuals, as for example Takeuchi and Sugimoto, who developed a smartphone application that guides and makes purchasing suggestions to shoppers in Japan [5]. The application of precise location-aware technologies to indoor navigation has been difficult to implement because of poor in-building GPS performance and the high cost of constructing indoor reference grids to duplicate the ranging functions performed outdoors by GPS satellites [6]. For certain applications, ultrawideband (UWB) technologies have shown considerable promise, although the implementation costs can be significant [7]. In a prior Journal of Rehabilitation Research and Development editorial, we reported on the James A. Haley Veterans' Hospital Polytrauma Transitional Rehabilitation Program (PTRP) Smart Home [1] that employs a UWB tracking system from Ubisense that is capable of resolving locations to around 20 cm (vs GPS's 3-5 m accuracy) anywhere in the facility. The system's Smart Home technologies permit selective medication prompting, automated check-in and check-out from the facility, and guidance to therapeutic sessions by presenting prompts on wall-mounted, touch-sensitive screens. To date, 30 PTRP patients have firsthand experience with the Smart Home tracking technology. While the Smart Home results have been generally positive, we encountered a human-factors issue while deploying this technology in that Veterans would sometimes miss or ignore a prompting message even though the screen delivering the message was very close to the Veteran. In an effort to address this issue, a metric was added to track the changes in Veterans' location. Confirmation that a Veteran saw and responded to the prompt was presumed when the change in the Veteran's location was to that of the prompted destination. Preliminary examination of the data indicated a nominal prompt compliance rate of 75 percent. While seemingly quite high, this can and should be increased. Providing auditory cues when a message appears on the screen may improve the response rate, but providing multiple auditory cues throughout the facility would be an annoying distraction to others. A more personalized approach might be for the Veteran to wear a wireless prompting device with the capability of providing vibrotactile, auditory, and/or visual alerts based on location context. It is axiomatic that poor compliance with a prompt will occur if the item to be acted on is a large distance away. For example, if a Veteran is prompted to take medication when the pill bottle is not in the immediate vicinity, the Veteran may say, "I must remember to take my medication when I get home. …