Co-Designing Interactive Technology For Patients With Dementia
By Hester Le Riche, CEO and cofounder, Tover
Dementia is personal for me, and not just because two of my grandparents are experiencing cognitive decline. When I was getting my Ph.D. in industrial design engineering and clinical psychology at the Delft University of Technology in the Netherlands, I spent a lot of time in care homes getting to know patients and understanding the challenges of their environment. As I built relationships with them, I had the opportunity — through technology design — to facilitate joy-filled moments among residents and between residents and their family members.
Using interactive light animation, I was able to help create experiences of engagement and joy for patients with dementia. Time and time again, I saw patients who were suffering from apathy, isolation, boredom, depression, and even physical limitations completely transform once they were introduced to purposeful play. While we might be able to temporarily detach ourselves from the sadness and discontent many living with dementia face, these are common emotions in senior care facilities. Considering over 55 million people globally are living with dementia, and this number is expected to reach 78 million by 2030, the issue will soon become personal for all of us.
In both the physical and cognitive arenas, intuitive solutions promote wellness and aid vulnerable patients via interactive play. Purposeful design processes and considerations are vital in transforming passive patients into engaged experiencers of the present moment.
Research In Design
Effective product design in healthcare has the power to change behavior and improve quality of life. To accomplish this, a designer needs to gain a comprehensive understanding of both the user and the environment. When considering altering behaviors of patients living with dementia in care homes, I performed a systematic literature review to learn how the environment influences the residents’ behaviors. From stimulation to motivation, it was important to understand the nature of their activities, the details of their physical spaces, and the nuances of their social environments.
As a designer, I believe co-design is critical to success. The end users and participants must be involved in the process. Designers need to be on-site so they can monitor conditions. In my case, I performed in-person research by observing residents and care providers, interactions among residents, and how these focus groups generally spend their days. My observations helped inform my design. For example, I noticed employees were generally overworked and had to straddle many tasks relating to both patient care and operations, so it became clear that my technology solution could not heavily demand the providers’ time. By watching and recording behaviors of residents with memory impairment, I consistently noticed patterns of passivity and apathy. Most of the residents had lost their ability to take initiative, so my design would also have to draw them in, inviting them to engage and interact. With an awareness of the residents’ tendency to remain idle or impassive, I set design intentions to break through apathy and stimulate physical activity in people living with dementia.
Technology Design And Development
My research of care homes, literature, and existing technologies addressing similar challenges in the market led me to one definitive conclusion: “Design for dementia” is utopia, not reality. The differences in patient presentations and behaviors from early-stage to late-stage dementia are extremely vast. Trying to design interactive play strategies for this entire population is akin to designing one toy to serve both a 3-month-old baby and a 12-year-old child. From a design standpoint, these variances in cognition are prohibitive. I researched the neuropathology of Alzheimer’s disease, including areas of the brain impacted, functions lost over time, and the order of these gradual losses. This process led me to target a smaller group, those with late-stage dementia who are in the last two years of life.
As I experimented with various forms of interactive mediums, it became clear that residents responded playfully to moving light. I initially experimented with colorful abstract shapes through projections, but residents weren’t sure what to do with those obscure visuals. Due to deficits in their prefrontal cortex, they did not take interest in unfamiliar images or shapes. Instead, I tried a beach ball projection, and group members all responded with enthusiasm — they knew how to hit a beach ball and keep it up in the air! No one had to think about what to do; beach balls had existed for their whole lives. Our team went on to design numerous games with other familiar objects that residents would intuit how to use and revisit simple experiences of their lives. The projections motivated each person to react, responding with movement and, quite often, a laugh, emotion, memory, or thought. The end design focuses on basic recognizable elements, eliciting cognitive responses and new experiences of vibrancy.
The projections act as a standing invitation to participate by capturing and holding the attention of residents. Further, the familiarity of the design components makes the interactions intuitive rather than exercises in uncertainty or confusion. It’s common for group activities intended to stimulate to sometimes have an adverse effect among people living with dementia — if they feel unsure or ashamed about the potential for “incorrect” participation, the resident will withdraw. From a design perspective, it was essential that the games and interactions couldn’t be done incorrectly or generate failure. They had to foster a safe environment where everyone could contribute comfortably to enjoy the present moment. Our technology, by design, enabled these special moments to unfold.
Drawing On New Knowledge
It’s important that technology design is iterative, with design teams on board to pivot and tweak the product to better fit the audience and goals. We work with care professionals, residents, and researchers daily to provide the best possible opportunities for people living with dementia and other cognitive impairments. Our users’ behaviors have a major impact on our game design. With their influence and feedback, we adjust our design through regular software updates with the goal of continuous improvement. The same goes for the impact of ongoing industry research. After I came across literature on the positive effect of music on people living with dementia, we developed a design sprint on music — how to incorporate it and optimally apply it to stimulate the brain. We are also using new knowledge to design more challenging versions of games to meet the needs of a wider audience, including those living with earlier stages of dementia.
From a co-design perspective, our games are never “finished.” Knowledge continues to unlock new playing fields in our designs and for people living with dementia. Amid all the objective measurements and ground truths in design, human beings — in their commitment to experience the environment and welcome new possibilities — are a major part of their own design tools.
About The Author:
Hester Le Riche is the CEO and founder of Tover. Combining industrial design engineering with clinical psychology during her Ph.D. at the Delft University of Technology in the Netherlands, she explored and developed how games and “purposeful play” could help people living with dementia. Her discoveries began the journey to her creation of the cognitive stimulation system the Tovertafel (or “Magic Table’” in Dutch), which uses interactive light animation to stimulate physical and cognitive activity and social interaction, with a proven track record of positively influencing quality of life.