First  thoughts  •  Brian’s issues all seem to relate primarily to the

symptoms of his underlying medical conditions.

•  Although he has identified specific areas where these symptoms cause him difficulty, it is likely that there will be other situations (both inside and outside the home) where the same symptoms will cause similar problems.

•  Therefore, our focus will be to try to remediate or compensate for these symptoms – in a manner, wherever possible, that can be transferred to other environments.

Assisting hearing at home and in public places

Listening  devices  •  It is likely that Brian will already have a hearing aid -

either supplied by the NHS, or privately purchased.

•  Research has found, however, that most people found it more helpful to wear two hearing aids at the same time (see Kochkin & Kuk, 2000).

Listening  devices  •  Hearing aid technology has progressed significantly,

and modern versions have been described as "high-tech computers" (Hear-it AISBL).

•  In addition, Brian may find a "personal listener" helpful (see Action on Hearing Loss for further information).

Boos2ng  the  poten2al  of  listening  devices  •  Induction loop or infra-red systems can be

installed within the home or car to filter out background noise - perhaps making it possible for Brian to listen to his music or TV at a lower volume (Action on Hearing Loss 2011).

•  These systems are designed to operate in a single room. However, an induction-loop or infra-red microphone may be used to transmit the sound of the door or phone ringing, as well as to help Brian to hear the voice of a caller.

•  They are often also used in public buildings such as cinemas (Action on Hearing Loss 2011).

Boos2ng  the  poten2al  of  listening  devices  

•  A wireless multi-alerting system, however, can be used with a pager or portable receiver to hear sounds throughout the home (Action on Hearing Loss, 2012).

•  Some examples of products

can be found here.

At home and when shopping

Enhancing  vision  in  the  home  Brian may wish to look at ways of preventing further degeneration of his eyesight.

One way of doing this may be by ensuring he has adequate lighting in the home.

He may want to consider some relatively simple changes to lighting that will make a huge difference to his vision around the home.

Click here for an informative slideshow on “Housing Design, Lighting and Visual Impairment” from the Thomas Pocklington Trust.

Enhancing  vision  directly?  •  Standard (magnifying) lenses are

relatively ineffective for AMD. Therefore, a number of alternative strategies have been developed, including:

•  Surgical implants (e.g. an intra-ocular lens for visually impaired people

•  Systems of Sight prismatic glasses (which look very similar to normal glasses).

•  A video magnifier such as the Vuzix SightMate can be used to optimise residual peripheral vision.

Shopping  •  If Brian is now finding his weekly shopping trips difficult, a

simple answer may be to order items online. •  Many of the devices previously mentioned for enhancing

vision directly could be used alongside a computer; or a PC could be adapted.

•  The RNIB now provides website audits to help improve accessibility for visually-impaired users.

•  See also details of the stores that the RNIB recognises as improving accessibility for the partially sighted.

Shopping  •  However, it is recommended that people with

congestive heart failure continue to exercise as much as possible.

•  Therefore, although Crosier (2009) found several barriers to shopping for blind or partially-sighted people, it may be best to encourage Brian to continue shopping in the ‘traditional’ way.

Naviga2on  to  and  from  the  shops  Smartphone Apps •  Brian may find using

mobile-phone software helpful for navigation.

Naviga2on  to  and  from  the  shops  Smartphone Apps •  Brian may find using

mobile-phone software helpful for navigation. •  They could help him

pinpoint his location should he become lost, and give him step by step directions either home or to a shop.

(e.g. GoogleMaps for Windows phone)

Naviga2on  to  and  from  the  shops  Smartphone Apps •  Brian may find using

mobile-phone software helpful for navigation. •  They could also help

with finding the right shops & facilities near to him. (e.g. AroundMe app for Smart phones)

Naviga2on  to  and  from  the  shops  GPS Hardware •  The Trekker Breeze uses GPS

within specialist hardware for blind or partially-sighted people.

•  Some automobile satellite navigation devices (e.g. The Garmin Nuvi series) are small enough to be hand held, can be voice activated and provide visual and vocal directions.

Naviga2on  to  and  from  the  shops  Obstacles •  Traditionally, visually-impaired

people may have been recommended a white cane to assist them in detecting obstacles.

•  Now, however, there are a series of electronic obstacle-detectors that Brian may find to be more user-friendly.

•  See Ball (2004) for some examples – ranging from add-ons to canes, to ‘sonic imaging’ devices.

•  Click the images below for two other interesting methods of detecting obstacles:

In  the  supermarket  •  Again, there are plenty of

Smartphone apps which can assist with shopping tasks:

In  the  supermarket  •  Again, there are plenty of

Smartphone apps which can assist with shopping tasks: •  TapTapSee uses a phone

camera to recognise objects and then ‘says’ what it is (Named App of the Month by RNIB in March, 2013).

In  the  supermarket  •  Again, there are plenty of

Smartphone apps which can assist with shopping tasks: •  TapTapSee uses a phone

camera to recognise objects and then ‘says’ what it is (Named App of the Month by RNIB in March, 2013).

•  ScanLife Barcode & QR Scanner recognises label codes and automatically finds product information.

In  the  supermarket  •  Shop Sense combines a

hand-held device with a re-design of the shopping experience.

Click picture for more details

In  the  supermarket  •  Shop Sense combines a

hand-held device with a re-design of the shopping experience.

•  The MediaCart combines in-store navigational technology with a barcode reader and voice-recognition technology, to integrate all aspects of shopping. Click picture for more details

Strategies  to  help  Brian  deal  with  his  memory  problems  •  One or more of the following strategies could be

adopted by Brian: •  Automatic pill-dispensers. •  More generic memory devices. •  Technology to help Brian exercise his memory

retention.

Automa2c  pill-­‐dispensers  •  Boots the Chemist have

agreed that they will fill the Pivotell pill-dispenser for users, so that the initial organisation process is no longer required.

Generic  memory-­‐aids  •  A large number of

mainstream devices are available to provide reminders of important events and information, including PDA and mobile-phone technology.

•  A smartphone app example could be a medication reminder (e.g. PillManager).

Generic  memory-­‐aids  •  Alternatively, products such

as the Pivotell Mem-X can be used to record messages which will give audible reminders of key tasks during the day.

•  Although Brian’s current difficulties are not sufficient to suggest a diagnosis of dementia, he may still find devices such as the MANA Calendar to be helpful.

Using  technology  to  exercise  memory  reten2on  

•  Although there is some disagreement in this regard, most studies suggest that cognitively stimulating activities are of benefit in enhancing or maintaining memory (see also: McDaniel & Vick, 2010; Hardy et al, 2011).

•  One promising application of this concept is the development of life-logging technology such as the Sensecam.

Home  monitoring  and  exercise  •  Telecare such as

Docobo's Doc@Home system allows daily monitoring of Brian's health status - reducing the need for repeated visits to or from healthcare providers.

Home  monitoring  and  exercise  •  Home exercise programmes

have been found to be beneficial for heart-failure, but some factors may prevent this, whilst some patients may be worried about over-exercising (Jolly et al, 2007).

•  The Philips Motiva system may therefore be useful, as it provides education and feedback in addition to monitoring.

•  The CARME study gives evidence that Motiva has a number of benefits for this patient group.

More  about  exercise...  •  Gentle exercise is recommended for

people with heart failure, such as walking and Tai Chi (Yeh et al, 2009).

•  Therefore Brian should be encouraged to engage in gentle exercise; but motivation can be difficult.

•  One solution may be to utilise pedometer (e.g. FitBit) and step counter (e.g. Pacer; Walk4Life) technology, some of which can ink to websites and phone apps to plan routes, log progress, create goals etc.

More  about  exercise...  •  Another answer to this may be to use

mainstream computer gaming technology for real-time feedback:

•  The new motion-sensing Kinect system has a game called Your Shape, which is an exercise package that includes Tai Chi.

•  The Nintendo Wii has the fitness oriented Wii Fit add-on, which is designed to help improve fitness, balance and muscle tone.

•  However, the movement involved in many of the Wii games can prove popular and intuitive for someone like Brian to use, and can help improve fitness without feeling like exercise.

Low  mood  &  loneliness  •  Technology could be most useful in assisting Brian to decrease his sense of

loneliness. •  He could use social networking sites such as Facebook to keep in contact with

friends •  He could join forums (e.g. perhaps one for bereaved spouses such as Widow.co.uk). •  He could use Skype or FaceTime to keep in contact with others.

•  There are a variety of websites and apps that may help him to manage his mood

•  MoodGYM is an online CBT based self help programme aimed at reducing feelings of depression and anxiety.

•  A tool like Lifepsychol (evaluated by HDTI, Coventry University) could be used to monitor his mood over time.

•  Five ways to Wellbeing is an app which looks at coaching the user to improving overall mental wellbeing.

•  Moodscope tracks mood but also provides a facility to share scores with friends/family enabling them to offer help to the user without needing to be asked.

Some  points  to  think  about  ...  •  As you can see, there is plenty of technology available to assist with each

aspect of Brian’s health issues. •  However, we need to remember to look at Brian’s issues holistically, bearing in

mind that what may work for him in one respect may be counteracted in another respect.

•  For example; •  There are a variety of mobile phone apps which can assist Brian with monitoring and

managing his own health, BUT what if his deteriorating eyesight means that he cannot see the screen?

•  There several physical devices (e.g. spectacles, hearing aids etc) that may help Brian interact with his environment effectively, BUT what if his memory problems means that he forgets to pick them up and wear them?

•  There is no right or wrong answer here – just a reminder that when considering which ATs might be useful for a person, it is important to consider ALL aspects of their health, abilities and circumstances.