The efficacy of an intelligent cognitive orthosis to facilitate handwashing by persons with moderate to severe dementia

Dementia reduces a person's ability to perform activities of daily living (ADL) because of the difficulty of remembering the proper sequence of events that must occur and how to use the required tools. The current solution is to have a caregiver continually provide verbal prompts. Family caregivers find assisting their loved ones to be particularly upsetting and embarrassing as it necessitates invasion of privacy and role reversal. It has been suggested that dependence on a caregiver might be improved using a cognitive orthosis that provides needed reminders and monitors progress. This paper will report on the results obtained from an efficacy study conducted with such a device. The COACH is a prototype of an intelligent computerised device that was developed to assist people with dementia complete ADLs with less dependence on a caregiver. The device was developed using a personal computer and a single video camera to unobtrusively track a user during an ADL and provided pre-recorded verbal prompts when necessary. It was tested with 10 subjects with moderate to severe dementia during handwashing in a study lasting 60 days. These trials showed that the number of handwashing steps that the subjects were able to complete without assistance from the caregiver increased overall by approximately 25% when the device was present. Individual changes ranged from approximately 10-45%. These changes were proven to be statistically significant at a 99% confidence level.