dewsbury linksell neuropaper 2011

8/3/2019 Dewsbury Linksell Neuropaper 2011

1/12

NeuroRehabilitation 28 (2011) 249260 249DOI 10.3233/NRE-2011-0653IOS Press

Smart home technology for safety and

functional independence: The UK experience

Guy Dewsburya, and Jeremy LinskellbaFlorence Nightingale School of Nursing and Midwifery, Kings College London, UKbNHS TORT Centre, Ninewells Hospital, Dundee, UK

Abstract. This paper proposes that people with neurological conditions can be successfully supported by smart homes only when

their needs and aspirations of the technological interventions are fully understood and integrated in the design. A neurological

condition can and does provide a clue to the finished technological design but this alone fails to personalise the system and stands

to be rejected by the person who requires the technology.

This paper explores the underlying issues of the complexity of this design process when designing for people with neurological

conditions, and advances a matrix to facilitate the assessment process to maintain a person-centred design of any system.

Keywords: Smart Home, technology, United Kingdom

1. Smart homes and disabled people

The notionof a smart homeis not new, and the use of

smart home technology has been used for many years

to support people in their own homes to lead more

independent lives [19,20,29]. We consider the main

smart houses in the UK.

Before undertaking this task it is important that we

address the question of what a smart house is. A smart

house is a house that has smart devices in it. Smart de-

vices are devices that can be programmed so that they

can determine their status in relation to other devices.

They can share any information that is available within

the system and the sophistication of individual devices

determines how many layers of functionality they can

each engagein simultaneously. For example a presencedetector, which is a sophisticated security sensor, can

provide automated controlof heating and lighting inde-

pendently of each other, whilst simultaneously offering

a security function and acting as part of a lifestyle mon-

itoring system. The ability to easily and independently

alter the relationships between devices and access all

available information within the system offers exciting

Corresponding author: Guy Dewsbury, Florence NightingaleSchool of Nursing and Midwifery, Kings College, London, UK.E-mail: [email protected].

possibilities for providing managed and interactive en-vironments. This paper will discuss both the localisedand global advantages of utilising such technology tosupport individuals with neurological conditions.

2. Smart homes and neurological conditions

Gentry [26] broadly covers many of the key aspectsof smart home technology in an excellent overview ofthe subject area. This paper and those by Rogoante etal. [46] and Rosen [47] on Telerehabilitation provideexcellent overviews of the differing relationships be-tween technology and people with neurological condi-tions. There is considerable material on the applica-

tion of smart home technology that incorporates many

aspects of the use of technology that can be applied topeople with neurological conditions [2,4,9,11,23,2931,37,41,51,54] but little real evidence of the applica-tion of smart home technology to support neurologicalconditions specifically. To this end, we will concentrateon the UK aspects of smart homes and their importancefor people with neurological conditions.

3. Smart homes in the UK

In the UK, the Assistive Interactive Dwelling (AID)house in Edinburghwas probably the earliest attempt to

ISSN 1053-8135/11/$27.50 2011 IOS Press and the authors. All rights reserved


2/12

250 G. Dewsbury and J. Linskell / Smart home technology for safety and functional independence: The UK experience

apply smart home technology to support independent

living [25]. The site functioned primarily as a demon-stration facility [6] but the design team were subse-

quently commissioned to create a Dementia smart flat

in Paisley. The layout was designed and generally re-

modelled to meet the needs of people with dementia,

which included the sympathetic design of doorways,

bathroom and gardens and it incorporated technology,

similar in configuration to the AID House. Glasgow

City Council wanted the flat to be able to accommodate

a wider range of disabilities and it was used by a young

adult with acquired brain injury. Members of the same

design team were also commissioned to design a sys-

tem for people with learning disabilities and challeng-

ing behaviour. This consisted of three properties; one

residential home for four people and two units, each

providing ten supported living accommodations. The

Commissioners introduction to smart home technolo-

gy had come via a visit to the CUSTODIAN smart flat

in Dundee (see below).

The other smart house system that was developed

alongside the AID House had limited success as a

demonstrator and was decommissioned but the design

team were invited to collaborate with the University of

Portsmouth [8] and John Grooms Housing Association

on a project where six out of 500 social housing units

were to have smart systems installed, with 3 wheelchairaccessible units of the ground floor and three prepara-

tory cabled units on the 1st floor. After some modifi-

cations, following the official launch, some technolo-

gy was used by the residents of all three ground floor

units. Also the same design team were approached to

install systems into two bungalows in Wigton, although

only one was eventually commissioned. It was initially

used by an elderly couple and was then occupied by a

physically disabled young adult.

In 1999 the Bath Institute of Medical Engineer-

ing (BIME), in conjunction with Dementia Voice

and Housing21, formed a consortium to develop the

Gloucester Smart House, which was launched in June

2000 [44]. It was designed as demonstrator to show

how smart technology can be applied sympathetically

and as a test bed for disability-specific devices. BIME

designed a number of devices, intended to support a

dementia sufferer. These included:

A bath monitor

A cooker monitor

A voice feedback system

Following the success of the Smart House in

Gloucester, Housing21 agreed to the installation of two

real-life installations, one in Bristol and one in Lon-

don, within extra care sheltered housing schemes. TheGloucester smart house closed in 2004 when the work

began on the Bristol flat. A detailed evaluation of the

use of the London flat has been performed with very

positive results, which indicated that key aspects of the

individuals lifestyle had been either retained or im-

proved with the support of the technology [45]. The

Bristol flat operated in a similar manner to the London

flat and although it never fulfilled its function as an

intermediate care facility, it is currently being used by

one long-term tenant with dementia.

Hereward College is a further education college

based in Coventry that has specialist facilities to cater

for students with impairments on a residential or day

only basis. The College has been incorporating tech-

nology within their residential blocks since 2001, on

an assessed need basis, with funding from the Learning

and Skills Council [7]. There are now 24 smart house

rooms at the College and it has recently installed an

iCue system into a cottage within its grounds in order to

provideintelligent management of a communal kitchen

area for a range of residents with cognitive impairment.

iCue, which is a proprietary system built on the expe-

rience gained within the Millennium Homes/Foresight

initiative described below, has also been implemented

in a number of technology demonstrator sites withinEngland recently, including the iHouse, with a number

of scenarios to support cognitive and sensory impair-

ment programmed in for illustration.

The Millennium Homes project led by Brunel Uni-

versity was funded to develop caring technology for

the elderly [21]. A demonstrator/evaluation cottage

was followed by the Caring Home Project that consist-

ed of twelve silent homes in Greenwich, which were

further described as caring not smart. However this

project led to the technology, known as Insight, being

implemented in a Supported Living Scheme, South-

wark, London. A review in 2005reported positive view

from residents and carers. There was also a private

purchase of a system for an individual, post-stroke.

In 1999 The Manchester Methodist Housing Asso-

ciation (MMHA), in collaboration with Bolton Coun-

cil, undertook two smart house projects, as part of a

regeneration project.

The Cedar Foundation in collaboration with Habin-

teg Housing Association currently has three active

smart facilities. Their first development was in Belfast,

which was opened in 2003 [27], which consists of two

blocks, each with four apartments on two levels. The

four ground floor apartments are fully accessible for


3/12

G. Dewsbury and J. Linskell / Smart home technology for safety and functional independence: The UK experience 251

wheelchair users and three of the upper flats are de-

signed for able-bodied individuals with brain injury orsensory impairment. The ground floor apartments of-

fer a full range of automation and safety monitoring.

The three upper apartments offer safety monitoring and

have preparatory cabling for full automation. An eval-

uation of the development, froma user perspective, was

published. Two further projects followed in 2007. The

developments offer a full range of automation and safe-

ty features and are intended for a mixed population of

wheelchair users, brain injury and sensory impairment.

The outcome of both developments are documented in

a report that provides insights into the value of smart

technologies for these client groups in facilitating and

developing supported living [39].

Reference has been made to the CUSTODIAN

project (http://www.scotmark.eca.ac.uk/research/58.

pdf), which was an EU-funded project from within

the TIDE programme that developed and evaluated a

user-friendly interface for designing smart home sys-

tems [12]. Health and Social Services within Dundee,

Scotland participated within the project and as a result

Dundee received a demonstration smart home, which

was used to develop interest in the technology from lo-

cal housing and care providers. A smart home system

was also provided to an individual with acquired brain

injury in her own home, which was the first recordedreal-life implementation of smart home technology to

meet a specified, neurological need [17,19,20]. This

individual continued to benefit from the technology for

a number of years and the demonstrator site provided

the impetus for developing the smart Transitional Liv-

ing Unit (TLU), which itself led to an number of sig-

nificant further smart home developments and imple-

mentations. These have included three supported liv-

ing developments for fifteen individuals with complex

needs and challenging behaviour, which had all previ-

ously been considered unsuitable for community-based

living; a custom designed new house for a tetraplegic

teenager to meet her long term needs; and, a signifi-

cant number of properties within Dundee City were in-

stalled with preparatory cabling for future smart home

implementation.

The smart TLU was a fully adapted flat devel-

oped jointly by The Centre for Brain Injury (CBIR)

and Dundee City Council as a Transitional Living Unit

(TLU) to support the rehabilitation and preparation for

dischargeof in-patients of the CBIR. Both partners sub-

sequently supported and funded the implementation of

an extensive smart house system within the TLU to

broaden the applicability of the TLU to in-patients of

the CBIR and explore its potential to supportrehabilita-

tion [35]. The complexities associated with managingand supporting hospital in-patients on non-NHS prop-

erty limited the ability to fully explorethese issues fully

and the facility has recently passed into the control of

Dundee City Social Work Department, via the Dundee

Telecare Project, who intend to use it as a demonstrator

and training facility as well as an assessment facility

for young adults with a range of disabilities.

A fully adapted smart house system has also been

installed in a cottage in Clackmannanshire that is in-

tended both for respite and assessment, for those with

physical and learning disability.

A number of privately funded installations have oc-

curred on an ad hoc basis and these include:

a custom-built house for a tetraplegic individual

a custom-built house for an individual with para-

plegia

a young adult with acquired brain injury

a custom-built extension to a house for 2 autistic

siblings

a woman with dementia whose carer was her hus-

band

There have been on-going ad hoc smart home im-

plementations within the UK that have continued at a

slow but steady rate over the last decade. Most of theprojects described have some relevance to neurological

conditions, covering a range of physical, sensory and

cognitive impairments. A lack of detailed reporting,

however, has limited the level and quality of knowledge

available for strengthening the on-going developments

4. Neurological conditions and smart homes

In England, smart homes were rejected in favour

of less complex systems through the introduction of

the Governments 2006 Preventative Technology Grant

(PTG) which provided money to all English local au-

thorities for telecare services.

As has been widely reported the uptake of telecare

by local authorities was patchy and no overall stan-

dards were embodied in their services [42]. Difficulties

aside, the PTG and its more formally structured coun-

terpart in Scotland, the National Telecare Development

Programme, allowed local authorities to embrace the

use of technology to support people. The focus was

supporting older people but many authorities took the

opportunity to see how telecare could be used to sup-

port people with other conditions. Telecare manufac-


4/12


turers recognised this and developed some condition-

specific sensors to support these efforts (most notablythe epilepsy sensors).

The extensive roll out of telecare has allowed many

observations to be made regarding the application of

monitoring and alerting technologies and these will be

considered in this next section, juxtaposed against the

more complex solutions that smart home technology

can offer. These observations are learned from the

personal and practical experiences of the authors who

were both directly involved in the design of technol-

ogy systems to support people; Guy Dewsbury was

a primary researcher on CUSTODIAN and was Tele-

care coordinator for a large London Borough and has

over fifteen years experience of designing technology

to support people including the design of 54 residences

for autistic adults in Scotland, whilst Jeremy Linskell

has fifteen years experience in assessing for and pro-

viding Electronic Assistive Technology (EAT) and has

designed and implemented a number of smart house

systems to support individuals with complex needs,

which commenced with participation in the aforemen-

tioned CUSOTODIAN project [16]. The authors there-

fore have considerable combined experience on practi-

cal perspectives as well as both authors working in the

field academically for over fifteen years.

Telecare deployment can be considered in a numberof ways. One of the more popular is to consider the

product output through things such as the post instal-

lation questionnaire [5] which locates the system from

the perspective of its effectiveness.

Within telecare there are a range of devices that are

commonly used, namely Pendant alarms; fall detec-

tors; bed occupancy sensors; pull cords; movement

sensors; Smoke/heat/flood detectors/carbon monoxide

monitors; automated lighting; location sensors; activi-

ty sensors; well being monitors; medication reminder

systems.

Pendant alarms are simple buttons usually worn

around the neck which when pressed cause the dis-

persed alarm unit, to dial out to a remote call centre.

Pendants can have different properties and assessment

fora pendant must ensure that the person has the capac-

ity and dexterity to actually use it. It is also important

that the dial tones from the dispersed unit can be turned

off so these do not trigger other side effects such as

seizures or confusion but doing so can remove the abil-

ity to cancel the alert. Pull chords are another method

of actively triggering an alert call and these must again

be configured around the individuals needs and abili-

ties. The flexibility of smart technology would provide

a system in which activation, feedback of activation

and method(s) of cancellation were fully configurable,within the living space, to meet the individuals cogni-

tive, sensory and physical abilities, which may change

significantly over time.

There are a range of devices, relating directly to per-

sonal safety or status that can trigger alerts. Fall de-

tectors are client-borne devices that can be worn in a

number of ways and depending on the sophistication of

the sensing technology have differing levels of accura-

cy and reliability. Importantly they rely on being worn

at all times and this may be inconvenient or impractical

of some occasions, some of which can be ameliorated.

For example failure to don the device at bedtimes can

be augmented with the use of bed occupancy sensors,

which would not necessarily cover day time bathroom

usage for instance, so such activities may require more

sophisticated methods of monitoring than simple sen-

sors. But even apparently straight forward usage would

benefit from intelligent information processing in or-

der to support decision-making. The individual with

Parkinsons Disease who has tripped and cannot rise

due to bradykinesia may self-manage with the support

of automated cueing, whilst the individual with the ear-

ly stages of MND who has fallen and cannot press a

pendant or rise because of reduced upper limb func-

tion will need assistance, and a confused older personmay be lying in distress for days and never consider

pressing a pendant for help. Aside from these issues

it is preferable to consider more intelligent technology

predicting possible falls and supporting the individual

in preventing such situations.

Occupancysensors have already been referred to, but

are not always appropriate or sufficient. An example

might be identifying when an individual with Huntin-

gons chorea has moved themselves into a compro-

mised position on their bed, as a result of their writhing

movements, and additionally proactively managing fall

prevention might involve predicting when someone is

about to leave their chair or bed.

Safety sensors such as heat or gas detectors have

legal requirements to provide loud audible warnings,

which may cause problems for some individuals, so

using such devices within a predictive protocol, to pre-

vent the situation arising, would be beneficial. This ac-

knowledgement of potentially harmful situations with

interactive response scenarios, which can be backed up

by remote alerting if necessary, offers significant flexi-

bility for supporting people with cognitive disabilities.

Epilepsy sensors can detect the shake of the tonic

phase of a seizure and some can also detect the limp-


5/12


ness of the clonic phase. Many epilepsy monitors are

rudimentary, consisting of simple vibrations sensors,which are difficult to tune to the individuals needs,

whilst sophisticated devices, based on pressure sensi-

tive film that can analyse many aspects of a beds oc-

cupancy and others that utilise a combination of sensor

inputs to analyse bed activity.

Movement sensors have changed little in the last ten

years and are often still big clunky things that glow

when activity is sensed and even when the glow is

switched off, they can produce adverse reactions from

confused people. There are a number of software suites

that use the information from these devices to produce

logs of a persons activity patterns over a day. Some

of these systems are very useful if used correctly but

it is difficult to not infer things from the evidence

they provide, and it is in fact now clear that much

additional contextual information is required to support

such usage [28].

Automation of functions such as lighting,doors, win-

dows and curtains offerssignificant benefits for individ-

uals with physical disabilities, but automation provided

via standalone sensors may prove limiting, by taking

the locus of control away from the individual. An indi-

vidual may have some physical skills that they wish to

maintain, or which may vary significantly over the day,

so having variable and transferrable methods of con-trol would be beneficial. Additionally automation may

not always be required or appropriate and the ability to

selectively disable automation may be of great benefit,

for doorways in confined areas for instance.

The use of technological interventions for cognition

is now well established [36] and a range of technolo-

gies from pagers [53] to PDAs [10] are regularly being

used in rehabilitation and to promote independence, es-

pecially for those with Acquired Brain Injury. These

devices provide a range of supports to assist in struc-

turing daily life, performing tasks and general orienta-

tion and there is also emerging evidence on the benefits

of this approach for carers [51]. It is clear that safety

and general monitoring capabilities as well as simple,

automated prompting could be beneficial for such in-

dividuals, but it is the potential interactivity of a perva-

sive smart technology that offers exciting possibilities

to provide context-specific feedback for many aspects

of daily life. With the recent appearance of many inter-

faces and gateways between smart home systems and

smart phones, the potential to implement this is avail-

able, and the ability to overlay this interactivity on-

to existing technological methodologies for cognitive

support, offers new possibilities in terms of enhanc-

ing independence for individuals with acquired brain

injury.Smart house technology, with its ability to utilise

all information within the system in a flexible manner

provides a number of advantages over an environment

supported by arrays of discrete devices alone. These

include the ability to selectively enable automation; the

ability discern levels of alert; the ability to combine

multiple alerts for a more textured monitoring configu-

ration; and, the ability to combine monitoringand alert-

ing to provide an interactive environment. In such an

environment, where there is no inherent differentiation

between information streams, and how they might be

used, a more person-centred approach is required for

indentifying the appropriateness of the system. This

requirement is compounded by the challenging nature

of integrating the more personal and social aspects of

the technology, as will be discussed in the next section.

5. The Neurological Dependability Assessment

Matrix (NDAM)

Putting the person into the assessment is a key fac-

tor in ensuring a person-technology-fit exists. Getting

the correct technological response for a persons needs,

experiences and wishes are critical. The authors ad-vance a matrix that is based on their research experi-

ence in the area for use in the technological assessment

of people with neurological conditions. The important

feature of the (NDAM) matrix is that it looks at the

persons needs, wishes and experiences as a method of

informing the assessment process. Therefore, it allows

the person to be more than their medical condition. Ex-

perience with working with people with a wide range

of neurological conditions dictate that no two people

experience their condition in the same way and that life

patterns can contribute to the relief or cause of further

episodes of a condition.

The matrix does not mean that the condition is not

important, rather that it is the outward expression of

how the condition is experienced and the resulting

needs and wishes that are mostimportant. For example,

two people with the same brain injury will experience

their injury in completely different ways. A condition

such as Apraxia, which is characterised by an inabili-

ty to carry out learned purposeful movements, can be

experienced differently by each person with the condi-

tion and their subsequent needs might be ignored in the

assessment for a potential technological solution. Sim-

ilarly two people with Parkinsons, displaying similar


6/12


Fig. 1. The Neurological Dependability Assessment Matrix (NDAM).

levels of impairment and problems with initiation, may

respond to completely different sets of cues.Post installation techniques [5] and methods that fo-

cus on the technology or the outcome without con-

sidering the whole person are fraught with danger astechnology mismatch can lead to technology rejection

or non-compliance. It is with these caveats that we

introduce the Neurological Dependability Assessment

Matrix (NDAM) (Fig. 1) which builds on the work

of [14,15,18,49] who developed a model, a method anda tool namely Dependability Model of Domestic Sys-

tems (DMDS), a Method of Dependable Domestic Sys-

tems (MDDS) and Dependability Telecare Assessmenttool (DTA). The model (Fig. 2) uses the ideas behind

dependability within computer systems as originated

by [33] and [3] and adapts them to a social context


7/12


Fig. 2. The Dependability Model Domestic Systems (DMDS).

of designing assistive technology systems for disabledpeople. The main points of this model is that it breaksthe social and technical aspects of designing technolo-gy systems for older or disabled people down into bitesize pieces and therefore allows the assessor to con-

sider a range of both social and technical issues thatare addressed in the subsequent Method of DependableDomestic Systems (MDDS). MDDS provides a num-ber of checklist questions for each box in figure oneand a range of suggested questions.

Essentially DMDS and MDDS promotes that thetechnology system needs to be Fit For Purpose in thatit does what it is supposed to do. It also is required tobe Trustworthy, such that the user will place trust andconfidence in the system. The system is also requiredto be Acceptable to the user in a number of ways andfinally the system should be able to be modified andadapted. MDDS follows the order of the DMDS dia-

gram (Fig. 2). Thegroupingof the items is a useful wayof trying to encapsulate a number of key dimensionsinto a small number of pointers.

Not all of the items in MDDS will be applicable to allAT devices or systems. MDDS users have to decide the

level of dependability and criticality (how critical thesystem is in relation to the user) of the system based ontheir professional expertise. This alters depending onthe type of system under consideration. Systems thatsupport life and with which failure could have catas-trophic reactions might require all the dependability as-pects to be considered, but in most cases this will notbe the case.

As the system increases in criticality, the more el-ements within the system are required to ensure thatthe system functions dependably. The table serves anillustrative purpose only to demonstrate the increase independability issues per system complexity. It is ac-


8/12


Fig. 3. The Relationship between Dependability features and Assistive Technology Outcomes.

knowledgedthat some apparently simplesystems might

have a number of dependability issues that are required

to be considered.

As the criticality of the system increases, more as-

pects are required to be considered. The professional

through close contact with the user best determines the

criticality of the system. Oftenthe persons needs are so

evident that the criticality of the system fits obviously

into one of the categories above (Fig. 3).

MDDS and DMDS gave rise to the Dependability

Telecare Assessment tool (Fig. 4)(http://thetelecareblog.

blogspot.com) which was developed specifically to as-

sist System Integrators in the in their assessment pro-

cess. This tool has the many of the same elements of

the DMDS diagram but also comprises elements such

as portability, comfort.

6. The application of NDAM

NDAM is a qualitative matrix that does not answer

questions, rather it provides them. The utility of the

matrix is that when someone with neurological diffi-

culties is being considered for technology the depend-

ability attributes serve as a simple interrogative guide

to the assessor to determine if the best solution is being

addressed. Through the use of the matrix it is envis-

aged that this will result in value for money as appro-

priate investments in technology, planning and man-

power (by taking into account the subjects personal

preferences/requirements).

NDAM assists the designer of the smart home by

assisting the interrogation of the system from the user

perspective.


9/12


Fig. 4. The Dependability Telecare Assessment tool (DTA).

7. Example of NDAM in action

A mother in her mid 30s with Multiple Sclerosis

lives with her 2 children aged 9 and 13. She lives

in a wheelchair adapted house. She has good use ofher arms and can self transfer although she is suffer-

ing increasing periods of weakness, and has fallen on

occasions when transferring. She has become slightly

forgetful and gets frustrated at her increasing difficul-

ties with performing unfamiliar, but seemingly simple

tasks. She has support from social services but her old-

est child provides a substantial amount of her informal

care. She is fiercely independent and is determined to

continue to care for her children independently. NDAM

allows the designer/reviewer to consider the mothers

actual needs against current provision and consider the

options for systems that can supplement the mothersabilities by producing prompts and monitoring her ac-

tivities to ensure the family is safe. The aspects of

fitness for purpose, trustworthiness, acceptability and

adaptability focus the designer on the whole system in-

cluding the family in the needs and wants based assess-

ment for technologicalsupport. It is the personalisation

and person-fit to technology that the success of failure

of an installation can be judged. NDAM can facilitate

better personalisation of technology and personalised

assessments; it adds the person and the technology into

the equation.

8. An appraisal of NDAM

NDAM is founded on well established roots but has

not officially been evaluated at this stage. What is evi-

dent is that is has been used, and like its predecessors,MDDS, DMDS and DTA have demonstrated, there is

a great need to have something that provides questions

rather than answers.

NDAM and smart homes are where the real evidence

can be uncovered. The use of NDAM in the design of

smart homes for people with neurological conditions

will enable bespoke solutions that reflect and meet the

needs of the potential occupants. NDAM focuses the

designer on the needs of the occupant as well as the

technology and serves as an integrator between the two,

mediating the challenges of any new and bespoke de-

sign. This nurturing element of a design can mean

that a person is in reality disabled rather than enabled

through the over protective and over prescribing asses-

sor. Technology should mitigate against but not re-

move elements of everyday living such as danger, do-

ing things for oneself that onecan do etc. A core essen-

tial philosophy that underlies NDAM is the rationale

that people must be encouraged to do for themselves

what they can actually do. NDAM personalises the

design and ensures that the expectations are actually

met and that a rational design is achieved which mixes

automation, monitoring, undertaking core tasks with

facilitating the person to achieve their own goals.


10/12


In the world of smart homes and assistive technology

where there are many outcome focused methods suchas PIADS [32,34]; LIFE-H [43]; Assistive Technology

Outcome Measure (ATOM) [22], OTFACT [48]; IPPA:

Individually Prioritised Problem Assessment [52]; it is

important that there is a qualitative technique of as-

sisting the assessment process which NDAM provides.

NDAM complements these other methods and supports

the development of questions; it provides no answers

but the questions are often the most important element

of an initial design. Failing to ask a significant question

canbe thedifference between an enabling and disabling

design.

9. The clinical applications of NDAM

NDAM provides a way of visualizing the core issues

faced by smart home providers and users, thus answer-

ing Gentrys plea for a mechanismin place to promote

collaboration among stakeholders [26, p. 215]. The

matrix provides a template for discussions and a plat-

form for all concerned parties to illuminate and justify

their concerns. It facilitates the designers/technologists

by providing a simple method of demonstrating their

worth and most importantly, it provides a traceable au-

dit trail of the key decisions that were reached in thediscussion. The different elements in each dependabil-

ity area provide a point of interrogation that should

be discussed with all stakeholders including the per-

son with the neurological condition. Finally, through

using NDAM the end user is provided with a voice,

and a way of articulating their needs to providers and

to have those needs and desires respected. NDAM is

not envisioned as a complete answer to all questions;

rather, it is a model that encourages clinicians to con-

sider the person, their environment, their needs and the

technological limitations that might apply in a particu-

lar situation. A key benefit of NDAM is that through

discussing the various elements and needs of a person,

a high-end solution may be reframed as a low-end so-

lution (instead of a sensor alerting someone a simple

bell might do the trick).

10. Conclusion

This paper has presented a brief overview of smart

homes in the UK in relation to their deployment with

people who have neurological conditions. The paper

demonstrates that the diversity of neurological condi-

tions means that the design of a smart home or smart

space cannot be guessed at but has to precisely meetthe needs and wishes of the person who will be using

the technologies. The paper has argued that although

there are many outcome measures applied to assistive

technology and assisted living, there are currently few

tools to assist the smart home designer. The paper then

advances the Neurological Dependability Assessment

Matrix (NDAM) as a qualitative assistance for thesmart

home designer to ensure that there is a technological-fit

and that the needs and wishes of the person requiring

the smart home are not overshadowed by complicat-

ed and often redundant technologies which could dis-

able rather than enable the person with the neurologicalcondition.

References

[1] T. Adlam and R. Orpwood, Off-the-Shelf Infrastructure inSmart Apartments for People with Dementia, in: Technologyand Aging: Selected Papers from the 2nd International Con-

ference on Technology and Aging, A. Mihailidis, J. Boger, H.Kautz and L. Normie, IOS Press, Netherlands, 2008.

[2] J.C. Augusto and C.D. Nugent, Designing Smart Homes: TheRole of Artificial Intelligence, Springer, New York, 2006.

[3] A. Avizienis, J.-C.Laprie and B. Randell, (2001) Fundamental

Concepts of Dependability. Research Report No 1145. LAAS-CNRS, April 2001.

[4] J.E. Bardram, A. Mihailidis and D. Wan, Pervasive computingin healthcare, CRC Press, Taylor and Francis Group, USA,2007.

[5] G.D. Baxter and A.F. Monk, A technique for the client-centredevaluation of electronic assistive technology, in: Contempo-rary Ergonomics, P. Bust, ed., London, UK: Taylor and Fran-cis, 2006, pp. 236240.

[6] S. Bonner, Assisted Interactive Dwelling HOUSE. In: Im-proving the Quality of Life for the European Citizen. Tech-nology for Inclusive Design and Equality, in: Improving theQuality of Life for the European Citizen, (Vol. 4), I. PlacenciaPorrero and E. Ballabio, eds, Technology for Inclusive De-sign and Equality: Assistive Technology Research Series. IOS

Press, 1998, pp. 396400.[7] I.D. Capel, H.M. Dorrell, E.P. Spencer and M.W. Davis, Theamelioration of the suffering associated with spinal cord injurywith subperception transcranial electrical stimulation, SpinalCord 41(2) (Feb 2003), 109117.

[8] K. Chapman and K. McCartney, Smart homes for people withrestricted mobility, Property Management20(2) (2002), 153166.

[9] D.J. Cook and S.K. Das, Smart Environments Technologies,Protocols, and Applications, John Wiley & Sons, Inc, 2005.

[10] K.D. Davies, S.E. Stock and M. Wehmeyer, Enhancing Inde-pendent Task Performance for Individuals with Mental Retar-dation Through Use of a Handheld Self-Directed Visual andAudio Prompting System, Education and Training in Men-tal Retardation and Developmental Disabilities 37(2) (2002),209218.


11/12


[11] G. Demiris, M. Rantz, M. Aud, K. Marek, H. Tyrer, M. Skubicand A. Hussam, Older adults attitudes towards and perceptionsof smarthome technologies: apilot study, Medical Informaticsand the Internet in Medicine 29 (2004), 8794.

[12] G. Dewsbury and M. Edge, Designing the Home to Meet theNeeds of Tomorrow . . . Today: Deconstructing and rebuildingthe home for life, Proceedings of the ENHR 2000 Conferencein G avle, 2630 June 2000.

[13] G. Dewsbury and I. Sommerville, CATS: Assisting Older Peo- ple Obtain Appropriate Technology Support, Proceedings ofHCI and the Older Population: A full-day workshop at BCSBritish HCI, Leeds, UK, 7 September 2004.

[14] G. Dewsbur, The Dependability Telecare Assessment (DTA)Tool, Pproceedings of W11 New Sociotechnical Insights inInteraction Design 2009: Bridging social requirements anddesign, Presented at Interact: 12th IFIP TC13 Conference inHuman-Computer Interaction, August 2428, Uppsala, Swe-

den, 2009.[15] G. Dewsbury, Using the Dependability Telecare Assess-

ment (DTA) Tool, The International Conference on Ageing,Disability and Independence (ICADI), Newcastle/Gateshead,September 2010.

[16] G. Dewsbury, S. Bonner, J. Linskell, S. Anderson, B. Taylor,M.Edge andJ.M.Ferreira, Final Evaluation of Tool Developedin Project, TIDE DE4004, D7.3, 2000.

[17] G. Dewsbury, K. Clarke, M. Rouncefield and I. Sommerville,Depending on Digital Design: Extending Inclusivity, HousingStudies 19(5) (2004), 811825.

[18] G. Dewsbury, I. Sommerville, K. Clarke and K. Rouncefield,A Dependability Model of Domestic Systems, in: Comput-er Safety, Reliability and Security: 22nd International Con-

ference, Safecomp, S. Anderson, M. Felici and B. Little-wood,Proceedings, Lecture NotesIn Computer Science. 2788,

Springer Verlag, Heidelberg, 2003, pp. 103115.[19] G. Dewsbury, B. Taylor and M. Edge, Designing Dependable

Assistive Technology Systems for Vulnerable People, HealthInformatics Journal 8(2) (2002), 104110.

[20] G. Dewsbury, B. Taylor and M. Edge, The Process Of Design-ing Appropriate SmartHomes: Including The User In The De-

sign, Proceedings of the EQUATOR Workshop on UbiquitousComputing in Domestic Environments Nottingham University13-14th September 2001.

[21] A. Dowdall and M. Perry, The Millennium Home: DomesticTechnology to Support Independent-Living Older People, Pro-ceedings of the EQUATOR Workshop on Ubiquitous Comput-ing in Domestic Environments Nottingham University 13-14thSeptember 2001.

[22] D.L. Edyburn, Technology enhanced reading performance:Defining a researchagenda, Reading ResearchQuarterly 42(1)(2007), 146152.

[23] M.J. Fisk, The implications of smart home technologies, InPeace SM and Holland C. Inclusive housing in an ageingsociety, Policy Press, UK, 2001.

[24] S. Fisk and H. Pigot, (eds), From Smart Homes to Smart Care:ICOST, 3rd International Conference on Smart Homes andHealth Telematics, IOS Press, 2005.

[25] D. Gann, J. Barlow and T. Venables, Digital Futures: Making Homes Smarter, Chartered Institute of Housing, Coventry,UK, 1999.

[26] T. Gentry, Smart homes for people with neurological disabili-ty: State of the art, NeuroRehabilitation 25 (2009), 209217.

[27] E. Gilliland and S. Martin, Evaluation of Hillmount CloseSupported Living Scheme, The Cedar Foundation, 2005.

[28] J. Hanson and D. Osipovic, Lifestyle monitoring as a predic-tive tool in telecare, Journal of Telemedicine and Telecare 13(2007), 2628.

[29] R. Harper, (ed.), Inside The Smart Home, Springer-Verlag,London Ltd, 2003.

[30] Helal, M. Mokhtari and R. Abdulrazak, The EngineeringHandbook of Smart Technology for Aging, Disability, and In-

dependence, John Wiley and Sons, Inc., Hoboken, New Jer-sey.

[31] D. Johnson et al., Virtual Reality: a new prosthesis for braininjury rehabilitation, Scottish Medical Journal 43 (1998), 3.

[32] J. Jutai and H. Day, Psychosocial Impact of Assistive DevicesScale (PIADS), Technology & Disability 14 (2002), 107111.

[33] J-C. Laprie, Dependable Computing: Concepts, Limits, Chal-lenges FTCS-25, the 25th IEEE International Symposium onFault-Tolerant Computing, Pasadena, California, USA, (2730 June 1995), 4254.

[34] J-C. Lenker and V.L. Paquet, A new conceptual model forassistive technology outcomes research and practice, AssistiveTechnology 16(1) (2004), 115.

[35] J. Linskell, The Transitional Living Unit: A Smart Solution,in: Practical Solutions to Support Communication, A. Wilson,ed., The CALL Centre, Edinburgh, 2006.

[36] E.F. Lopresti, A.Milhailidis and N. Kirsch, Assistive Technol-ogy for Cognitive Rehabiliation: State of the Art, Neuropsy-chological Rehab 14(1/2) (2004), 539.

[37] W.C. Mann, Smart Technology for Aging, Disability and In-dependence: the State of the Science, John Wiley and Sons,2005.

[38] M. Marshal, ASTRID: A Social and Technical Response toMeeting the Needs of Individuals with Dementia and Their

Carers, Hawker, UK, 2000.[39] S. Martin and E. Beamish, Evaluation of Ardkeen Support-

ed Living Option. Social Research Centre, 2008. http://www.cedar-foundation.org/common/publications/PDF/Report-Final-11Feb08.pdf.

[40] S. Martin, G. Kelly, W.G. Kernohan, B. McCreight and C.Nugent, SmartHome Technologies for Health and Social CareSupport(Review), The Cochrane Library, Issue 4, 2008.

[41] C. Mayra and C. Koskinen, (eds), The Metamorphosis ofHome: Research into the Future of Proactive Technologies in

Home Environments, Studies in Information Sciences series.Tampere, Finland: Tampere University Press, 2005.

[42] N. Merrick, Watchful Eye, Inside Housing. 05/09/2008.[43] L. Noreau, P. Fougeyrollas and C. Vincent, The LIFE-H: As-

sessment of the quality of social participation, Technology andDisability 14 (2002), 113118.

[44] R. Orpwood, The Gloucester SmartHouse, Journal of Demen-tia Care 9 (2001), 2831.

[45] R. Orpwood, T. Adlam et al., Evaluation of an assisted-livingsmart home for someone with dementia, Journal of AssistiveTechnologies 2(2) (2008), 1321.

[46] M. Rogante, M. Grigioni, D. Cordella and C. Giacomozzi,Ten years of telerehabilitation: A literature overview of tech-nologies and clinical applications, NeuroRehabilitation 27(4)(2010), 287304.

[47] M. Rosen, Telerehabilitation, NeuroRehabilitation 12(1)(1999), 1126.

[48] R.O. Smith, OTFACT: Multi-level performance-oriented soft-ware with an assistive technology outcomes assessment pro-tocol, Technology and Disability 14 (2002), 133139.

[49] I. Sommerville and G. Dewsbury, Dependable Domestic Sys-tems Design: A Socio-Technical Approach, Interacting withComputers 19(4) (2007), 438456.


12/12


[50] D.H. Stefanov, The Smart House for Older Persons and Per-sons With Physical Disabilities: Structure, Technology Ar-rangements, and Perspectives, IEEE Transactions On NeuralSystems And Rehabilitation Engineering 12(2) (2004), 228250.

[51] T.W. Teasdale et al., Alleviation of carer strain during the useof the NeuroPage device by people with acquired brain injury,

J Neurol Neurosurg Psychiatry 80 (2008), 781783.[52] R. Wessels, J. Persson, . Lorentsen, R. Andrich, M. Ferrario,

W. Oortwijn, T. VanBeekum, H. Brodin and L. de Witte, IPPA:Individually Prioritised Problem Assessment, Technology and

Disability 14 (2002), 141145.[53] B.A. Wilson, J.J. Evans, H. Emslie and V. Malinek, Evalua-

tion of NeuroPage: a new memory aid, J Neurol NeurosurgPsychiatry 63 (1997), 113115.

[54] W. Zagler and P. Panek, Assisting the facilitators interfacedesign and telematic support for IT-based assistive technology,Technology and Disability 10(2) (1999), 129137.

dewsbury linksell neuropaper 2011

Documents