Computer system for cognitive rehabilitation

Description of equivalent WO 9708605 A2

COMPUTER SYSTEM FOR COGNITIVE REHABILITATION

BACKGROUND OF THE INVENTION

0003The present invention pertains to a holistic system which employs computer hardware, software and peripherals, as well as training, monitoring and evaluation in the management and remediation of cognitive deficits found in persons who have suffered brain injury or deterioration as a result of trauma or disease.

0004Persons with cognitive disorders resulting from birth defect or injury to the brain have symptoms which include lack of orientation to time and place and the inability to recall, organize and process information. These injuries may be caused by trauma, disease or deterioration and include aging, alcoholism, drug dependency, stroke/Alzheimer's disease and severe head wounds. Patients with such cognitive disorders require considerable assistance in managing their daily activities. A widely used source of assistance is a personal caregiver - usually a close family member. Further assistance may be provided by prosthetic memory devices such as notebooks, daily organizers, personal pagers and/or computers. These devices or systems provide memory assistance in many areas of daily life management. Examples of such supported daily functions are time orientation and management with appointment reminders and deadline cues, specific task guidance and coaching, journaling of daily events, telephone contacts, help information, maintenance of directories, planning and cuing of daily chores and responsibilities, money management, support of self care and grooming, performance of specific vocational tasks and tracking school assignments and homework. Computer systems, along with logic puzzles, word games, etc. may also be used as ortheses to facilitate cognitive remediation. Such systems support the organization, planning and management of assignments which are fundamental to the everyday existence

0005of the patient and they additionally provide the patient with the encouragement and confidence

0006required to reenter the greater community.

0007The goal of cognitive rehabilitation is to enhance the ability of the patient to adapt at home, in the community and at work or school, and to increase the patient's function and independence. An Additional goal of cognitive rehabilitation is to systematically increase the patient's functionality through redundancy. Experience has shown that computers can be effective tools in the management and remediation of cognitive deficits when they are integrated in a comprehensive system of cognitive care and continued usage of the present invention is expected to strengthen short term memory thorough repetition and to assure that cognitive gains are not lost through memory seepage.

0008There are a number of computer systems presently available on the market which are frequently employed in the management of cognitive deficits. Typically such present day systems include ordinary notebook and desk top computers which are usually coupled with word processing software and organizing software.

0009Other such systems are much simpler in function and generally consist of nothing more than a memory jogging device or cuing device, or a paging device. These devices employ traditional day timers or daily organizers found in portable computer form for normal office use.

0010One of the more recognized computer orthotic systems presently found on the market is sold under the trademark NeuroPage. Another such system is sold under the trademark MNEMOSYNE. The former is a prosthetic alpha numeric paging system which provide reminders to individuals with memory deficits throughout the day. The latter utilizes conventional Macintosh or IBM compatible (PC) desk top computers or a notebook computer for patient use.

0011These devices clearly promote independence for people with cognitive deficits and also free up the time of professional staff or therapists. However, they do exhibit some shortcomings which die computer orthotic and prosthetic system of the present invention overcomes.

0012The computer orthotic systems of the prior art do not permit communication with the patient in all possible modalities (tactile, visual and audio), do not permit remote programming by the therapist of a truly portable device that is readily carried by the patient, do not permit assignment of priority and difficulty levels to tasks to be performed by the patient, and do not permit remote downloading of patient input data to the therapist for analysis, and do not in and of themselves actually assist in such analysis, nor have a

0013capability of compiling or printing progress and diagnostic reports. The systems of the prior art provide no means for soliciting, recording and storing patient responses to each message, which can be later remotely downloaded and analyzed so as to monitor and adjust the system to the patient's changing needs and support continued movement toward increased independence and capability.

0014The inventors discovered these deficiencies and concluded that a system which overcame these shortcomings would be much more beneficial in accelerating the patient's rehabilitation, while, at die same time, providing the patient with much more independence and confidence man therefore possible to attain through die use of computer orthotic systems or memory jogging devices presently on the market.

SUMMARY OF THE INVENTION

0016The patient management system of die present invention includes computer data processing systems with peripherals, and software for these systems. The software allows for programming, training, monitoring and evaluation. This holistic system tiierapeutically assists die rehabilitation process for a patient requiring cognitive intervention by providing a truly portable, programmable data processor adapted for use by persons with cognitive deficits.

0017The prescribed plan for a particular patient is entered into die tiierapist's computer which is typically a general purpose processor linked to die patient's base computer

0018tfirough conventional modem. The patient's base computer interfaces (communicates) with its attached docking station to download die prescribed patient activity information (including specific task instruction when needed) into the patient's hand held device (portable processor). The docking interface not only allows die patient or caregiver to download die patient's daily schedule from the tiierapist's computer, but also allows die patient or caregiver to make certain additions or changes to die daily schedule as situationally required (i.e. time change in a scheduled appointment.

0019This stored prescription activity information is communicated (usually unsolicited) on a scheduled basis to the patient by the portable processor for patient response. Priority levels and difficulty levels are assignable to specific tasks to be carried out by die patient for later tiierapist reference and evaluation. The patient is solicited to respond to die scheduled activity information. This patient response information is recorded and stored in die portable processor as input by die patient in response to die communicated activity information. The stored patient response information is periodically uploaded from die portable processor through die base computer/docking station via modem to die tiierapist's computer for monitoring and analysis. This analysis can aid die tiierapist in monitoring a patient's progress and determining die efficacy of die prescribed patient program.

0020Generally die portable processor is programmed from die tiierapist computer tiirough a modem, a base computer data processor located at die patient's home and a docking interface for communication between die portable processor and die base processor.

0021The therapist processor is also preferably programmed for analyzing this patient response information and for providing progress reports. The analysis can assist die tiierapist in determining die effectiveness of prescribed medication on die patient. The docking station interfaces with the patient's base computer which allows die patient or caregiver to download his or her daily schedule from die tiierapist's computer to the portable processor and to upload a record of his daily activities and responses to the

0022therapist's computer on a periodically scheduled basis. Further, die docking station will allow for checking die status of die portable processor's batteries and recharging diem as necessary.

0023The tiierapist's computer maintains a database of die patient's activities and responses to portable processor transmissions, and checks status of die batteries in die hand held device (botii of which have been uploaded tiirough die base computer/docking station). The therapist's computer also downloads any changes to die patient's daily schedule and generates forms and reports required for die patient's case management.

0024Accordingly, tiύs holistic, computer based, orthotic and prosthetic system of cognitive remediation is sensitive to die requirements of die individual patient, greatly reduces tiierapy time, and tiierefore cost, frees up die therapist, die institution and die caregiver from much of die intensive personal tiierapy time, as well as provides the patient widi increased independence and self esteem.

0025The patient portable processor generally includes an operative interconnected combination of a microcontroller, data storage memory, a signal alarm, a message transmitter, a patient response input, a power source, and an interface adapted for communication connection to die base processor. The power source will generally consist of a rechargeable battery tiiat is adapted for recharging tiirough the interface widi die base unit.

0026The signal alarm may be an alarm of any selected modality, such as a tactile, visual or audio alarm and may be of any required intensity and repetitive application. Similarly, die message transmitter which transmits die messages from die portable processor to the patient may signal in one or more modality, such as a tactile, visual and/or an audio transmitter.

BRIEF DESCRIPTION OF THE DRAWINGS

0028Otiier objects and advantages appear hereinafter in die following description and claims. The accompanying drawings show, for die purpose of exemplification, witiiout limiting die invention or claims thereto, certain practical embodiments of die invention wherein:

0029FIG. 1 is a schematic block drawing providing a diagrammatic overview of die computer orthotic and prostiietic system of the present invention;

0030FIG. 2 is an enlarged view of die patient portable processor portion of die system shown in FIG. 1;

0031FIG. 3 is a hardware schematic block diagram of die patient portable processor shown in FIG. 2; FIG. 4 is a software flow chart overview for die computer system of FIG. 1 ;

0032FIG. 5 is a detailed software flow chart for die alarm signal portion of die patient portable processor unit of FIG. 2; and

0033FIGS. 6a, 6b and 6c show in combination a detailed software flow chart for the patient instruction and response functions of die patient portable processor unit of FIG.

00342.

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT

0036Referring to FIG. 1, a diagrammatic overview of the computer system 10 of die present invention for tiierapeutically assisting in rehabilitation of a patient having cognitive deficits is illustrated. The system 10 consists of tiiree basic components; namely, die base unit or computer data processor 11 , die therapist computer data processor 12 and die portable programmable data processor or device 13.

0037The base unit 11 and die tiierapist processor 12 are general purpose processors, such as commercial PC computers widi FAX modems. The tiierapist's processor 12 is remotely located for convenient access by die tiierapist and die base unit or processor 11 is usually located at die home or office of die patient to be treated and is operated by the patient or a caregiver. The portable programmable data processor 13 is custom manufactured and adapted for mobil use by die patient. Detail of die portable programmable data processor 13 is illustrated in FIG. 2.

0038The tiierapist communicates with die patient devices (base unit PC 11 and portable processor or device 13) tiirough die FAX modem connection 14.

0039The function of the base unit or processor 11 is to provide a communication link between the therapist and die portable device 13, and to program die portable device 13. The base unit 11 further includes a communication/battery charger link to the portable device 13.

0040The portable device or processor 13 is a hand held device (could be as small as a cellular telephone) tiiat die patient can readily carry. The device is powered by internal rechargeable batteries and die portable device 13 is connected to die base unit (hereinafter referred to as docking) tiirough a serial upload or interface 15 at die patient's or caregivers convenience for the exchange of information and battery charging.

0041Widi particular reference to FIG. 2, the portable device or processor 13 has a visual text (LED or LCD) display 16 and a brightness control 17, provided in die upper half 18 of die closeable hinged case 19.

0042The lower portion 20 of case 19 is provided with a speaker 21 with volume control 22 and a microphone 23 for recording personal notes. Keys 24 are provided for die patient to respond to die vibratory, audio and visual prompts. Scroll up and scroll down keys 25 and 26 are provided so tiiat the patient can scroll up and scroll down through die prescribed patient activities programmed into the

0043device 13 so tiiat he or she can preview die prescribed day or week activities on display 16. The patient can also use the same scroll keys 25 and 26 to sequence through instruction steps.

0044As opposed to prior art devices previously mentioned, die number of keys are limited so tiiat cognitively challenged persons can cope with the frustration and stress experienced in working with die portable device 13. Also shape and color of die keys may be specified by die tiierapist.

0045The portable processor or unit 13 is also provided widi alarms (tactile, visual and audio) and a communication port (not shown in FIG. 2). These devices and die basic hardware components of die portable processor unit 13 are illustrated in block diagram form in FIG. 3.

0046The portable processor 13 includes an operative interconnected combination of a microcontroller 30, which includes data storage memory, signal alarms (tactile, visual and audio) 31, and interface 15 in the form of a serial interface for communication connection to the base processor 11, when the portable unit is docked.

0047The portable unit 13 further includes a digital speech processor 32, a serial flash eeprom 33, a CODEC 34, amplifiers 35 and 36 for respectively driving speaker 21 and amplifying signals input tiirough microphone 23. Microcontroller 30 communicates to the base unit 11 tiirough the serial interface 15 when docked. The microcontroller will download information from base unit

004811 through die digital speech processor 32 and into serial flash eeprom 33. Microcontroller

004930 is capable of uploading information from the serial flash eeprom 33 through the digital speech processor 32 and into die base unit 11 tiirough serial interface 15.

0050Microcontroller 30 is programmed to monitor the time and alert die user through die alarms 31 (eitiier as a tactile, visual or audio alarm as selected by die tiierapist) when a message is to be displayed on display 16. Microcontroller 30 will display die message visually on die display 16 and also audibly tiirough die speaker 21. Microcontroller 30 is also programmed to manage die recording of personal notes via speech through microphone 23 input by the patient or caregiver.

0051The alarms consist of an audio signal which is communicated tiirough speaker 21, a visual signal through a flashing LED (not shown), and a tactile signal tiirough a vibrator (not shown). These alarms are all diagrammatically displayed as element 31 in die block diagram of FIG. 3.

0052Digital speech processor 32, under control of die microcontroller 30, will process information from the microcontroller or the microphone for storage in the serial flash eeprom 33. The digital speech processor 32, under control of microprocessor 30, processes information from serial flash eeprom 33 to either the microcontroller 30 or the speaker 21. Serial flash eeprom 33 functions as a storage device for botii audio and text information. Serial flash eeprom 33 accordingly functions as additional data storage memory for portable processor 13. CODEC 34 functions as an interface providing analog to digital and digital to analog conversions for die digital speech processor 32 and for amplifiers 35 and 36 connected respectively to speaker 21 and microphone 23. Amplifiers 35 and 36 for die speaker and microphone provide proper signal levels and volume control.

0053Speaker 21, alarms 31 and display 16 function as message transmitters. User keys 24 function as a patient response input. Microphone 23 may also function as a patient response input.

0054The rechargeable battery unit which powers portable processor or unit 13 is not illustrated in FIG. 3.

0055Portable processor 13 is programmed for recording and storing patient response information entered tiirough die patient response input, such as input keys 24. The base unit 11, therapist PC 12 and portable processor 13 are programmed for upload programming of die portable processor 13 widi prescribed patient activity information through base processor 11 and die interface 15 from die remotely located tiierapist PC or processor 12 for controlling the operation of the portable processor 13 to communicate the prescribed information to the patient on a scheduled basis. All of these processors are also programmed for downloading patient activity response information from die portable processor 13 tiirough interface 15 and base processor or unit 11 to remote tiierapist processor or PC 12 for analysis. An overview of the system software is provided in die software flow chart of FIG. 4.

0056Software options and screens are described as numbered in FIG. 4. Messages menu option screen 1 brings up the Message Type List screen la which brings up current messages by their categories, e.g., Medical, Personal, Work, Social, Domestic, and All.

0057Message Input and Review screen lb reviews, edits messages and sets signal variations. Set Degree of Difficulty screen lc, enables the therapist to analyze patient responses based on task difficulty levels preset by tiie therapist.

0058Patient Files menu option 2, brings up Patient File List screen 2a and lists

0059patients to be selected by name. Patients Message List screen 2b, lists selected patients current messages. Add New Message screen 2c, permits addition of new messages as well as signal time, day or date.

0060Priority level menu option 3 brings up the Set Priority Level screen 3a, which enables the therapist to assign a priority level to prescribed activity messages based on importance. Priority levels assign die number of signals and intervals of signals communicated to or subjected to die patient.

0061Response Analysis menu option 4, brings up the Response Analysis screen 4a and permits an analysis of die patient or patients based upon die following screens and tiieir options.

0062View and Print Report By Message screen 4b permits patient analysis based upon selected messages for success rate or progress to be viewed or printed on a report. View and Print Report by Dates screen 4c permits patient analysis based upon selected date for success rate or progress to be viewed or printed on a report. View and Print Report by Degree of Difficulty screen 4d permits patient analysis based upon degrees of difficulty for success rate or progress to be viewed or printed on a report.

0063PMA is an intended trademark of die inventor's for die portable processor unit

006413 and PMA Simulator menu option 5 brings up the Patient List for Simulation screen 5a and permits selection of patient by name for PMA or portable unit simulation. PMA Simulation screen 5b displays an actual simulation of the portable unit device itself and the messages as they would be displayed.

0065FIG. 5 is a detailed software flow chart illustrating the required programming for the alarm signal portion of the patient portable processor unit 13. In other words, this flow chart shows one of two modes for die portable unit operation. This is die first mode of operation when die microcontroller 30 in the portable unit 13 alerts die user or patient that it is time to respond to a message. The second mode of operation is when the user desires to review/preview messages or record a personal note. This second mode is illustrated for programming in die detailed software flow chart of FIGS 6a, 6b and 6c.

0066The software flow charts of FIGS. 5 and 6 are selfexplanatory to those of ordinary skill in the art of computer programming. It will be readily understood that a computer programmer of ordinary skill, upon viewing die software flow charts of FIG. 4, 5 and 6 will be readily capable of writing the necessary program to carry out the functions displayed and required in order to operate die computer system of die present invention as described and claimed.

0067The computer system 10 of the present invention is thus programmed so that the portable computer data processor 13 can be programmed remotely from die therapist computer data processor 12 for storing prescribed patient activity information for a patient. Portable processor 13 is further programmed to communicate die stored activity information on a scheduled basis to the patient for solicited patient response and further programmed to

0068record and store patient response information input by a patient on die keys 24 in response

0069to die communicated activity information.

0070The system is also programmed for permitting the portable processor to be downloaded to die remote therapist computer data processor 12 for retrieving the stored patient response information for analysis.

0071The therapist PC or processor 12 is programmed to analyze die patient response information and to provide analysis reports. The tiierapist's PC 12 is further

0072programmed to assign priority and difficulty levels to prescribed tasks of die patient activity information as input by the tiierapist to assist die analysis process.