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A CUSTOM-FITTING COGNITIVE ORTHOTIC THAT PROVIDES AUTOMATIC PLANNING AND CUEING ASSISTANCE
Attention Control Systems, Inc.
Phone: (650) 494-2002
I. OVERVIEW OF PEAT
The Planning and Execution Assistant and Trainer (PEAT) is a unique assistive technology for persons with cognitive disorders[1,2,3]. The cognitive impairment may be due to brain injury, stroke, multiple sclerosis, autism, Alzheimer's disease, attention deficit disorder, developmental disorders or other causes. PEAT is particularly designed to help users with executive function impairments such as activity planning, initiation, error-detection and error-correction.
PEAT helps users complete their daily living activities with less help from caregivers. It is the only system that provides automatic assistance for task planning, performance monitoring, and error-correction. This provides the flexibility that is necessary to accomplish goals despite uncertainty and changing situations.
PEAT's patented technology  for integrated task planning and execution is a spin-off from NASA's robotics research. The relation is that NASA's autonomous spacecraft and rovers on Mars require the same flexibility as people to accomplish goals in uncertain and changing situations. PEAT is an application of this technology on handheld computers for the purpose of cognitive rehabilitation.
Like an orthotic for the foot, a cognitive orthotic must fit the user well to be effective. A customized foot orthotic based on a plaster cast of the user's foot will be much more effective than an off-the-shelf product that is bought at the local pharmacy. The same is true for a cognitive orthotic. One cannot expect to apply a one-size-fits-all solution to the individual needs of persons with cognitive disorders. PEAT is designed with this in mind, and is
customized to meet individual needs, and to provide the best possible fit for each user.
PEAT is an electronic memory notebook with four main sections: Cue Card, Calendar, Names and Notes. The Cue Card section provides cues the user about the current activity only. The Calendar, Names, and Notes sections are similar to those found in other systems. The information in all of these sections can be linked to each other for easy cross-referencing. PEAT provides integrated voice recording that can be used for Cues and attached to Name or Note cards. Digital pictures can also be attached to Cues, Names, and Notes.
In this paper, we first present an overview of PEAT's automatic planning and execution methods, and then we describe how PEAT is individualized to provide a custom-fitting cognitive orthotic.
II. PLANNING AND CUEING ASSISTANCE
There are several ways that PEAT helps with automatic planning and cueing. These patented  features include:
- Floating Tasks - Floating tasks are tasks with flexible start times (like shopping or laundry), compared with Standard tasks with fixed start times (like a movie or doctor's appointment). Floating tasks have flexibility to be delayed when higher priority tasks are added. For example, you can specify that a 1-hour Lunch task occurs everyday between 11:00am and 2pm. Since Lunch will take only one hour within this 3 hour window, it could start as late as 1pm. If a floating task is delayed past its deadline, Peat will automatically detect the problem, alert the user, and provide options for correcting it. For example it could extend the deadline past 2pm or it could shrink the duration of lunch to be less than one hour.
- Task Scripts - Task scripts guide users through hierarchical, multi-step procedures and daily living activities. Each script describes a sequence of tasks, and each of those tasks can be a script. It is a lot like a task outline or a "work-breakdown-structure". For example, a Morning Routine script might look as follows:
Morning Routine Script:
- Wakeup (5 minutes)
- Shave (2 minutes)
- Shower (6 minutes)
- Comb Hair (2 minutes)
- Get Dressed (10 minutes)
- Put Cereal in Bowl (2 minutes)
- Eat cereal (6 minutes)
- Put cereal away and bowl in sink (2 minutes)
- Travel Tasks
Travel Tasks provide an advanced form of planning in PEAT. Travel tasks are tasks that PEAT automatically adds to the schedule for traveling between two locations. If one task is followed by another task that is in a different location, then PEAT can automatically add a Travel Task for traveling between the two locations. For example, if the task "Class" is at location "school", and it is followed by the task "Therapy" which is at location "Hospital", then PEAT may add a 25 minute travel task to travel from the school to the hospital.
- Integrated planning and Execution
One of PEAT's most unique features is that it "closes-the-loop" between planning and execution. Instead of assuming that the plan will be executed exactly as specified, PEAT assumes that the plan may change during execution. To accommodate this, PEAT monitors the user's progress during task execution and adjusts the schedule when necessary.
- Cueing - PEAT provides automatic cues to remind the user when to start and stop tasks according to the current schedule. These cues provide the Task Execution part of PEAT. Various cueing options will be discussed in the section below called "Matching Individual Needs".
- Execution Monitoring - PEAT monitors task execution in two ways. It notices when the user responds to a start or stop cue and if they delay schedule by selecting the "wait/snooze" button. PEAT also notices whenever a task is added, removed, or changed in the calendar because that may impact the current plan.
- Error detection and correction - Whenever the user responds to a cue or changes the calendar, PEAT will propagate the new information through the rest of the schedule. If the user delays lunch too long or adds a phone call to the schedule, PEAT may notice that the user will miss the deadline to catch a bus. It will then warn the user and provide options for resolving the problem.
III. MATCHING INDIVIDUAL NEEDS
There are several ways that PEAT is customized to meet individual needs. These include:
- User Interface - The most important way to individualize PEAT is by changing the user interface. You can remove any button that appears on the screen so that the user sees only those options that they will use. For example, a user who is not able to use a "wait/snooze" button, will not see that button, but another user might. You can also control which parts of PEAT the user can access. For example a user may be restricted to the Cue Card section only. In this case they can only respond to cues, without the ability to look at the full calendar, change the schedule or modify the names or notes sections. In this "Cue Only" mode the system function like a pager.
The level of cueing can be adjusted in various ways. First, you control whether you receive start and stop cues for each task. Second, you control the level of detail for cueing. For example, you may provide a single cue for a "Dinner" task, or you may break that down into several steps and provide cues for each step. Third, you control the Cue sound by making a custom voice recording, choosing from a variety of built-in sounds, or downloading custom sounds from any computer. Integrated voice recording enables a wide range of cue options because the prompt may be general like "Did you clean up after breakfast?" or specific like "Put the cereal on shelf and the bowl in the sink". Fourth, you can add digital pictures that provide pictures from the user's actual environment. For example, the cue to "Make Bed" may include a digital picture of the user's actual bed, and the cue to "Call Dr. Smith" may include a digital picture of the doctor. This helps users who have difficulty w! ith abstraction or printed words.
- Activity Model - The activity model describes the user's daily living activities. This is one of the most important ways to get a better fitting orthotic. Other systems typically require that you model the user's activities with only one type of task, which starts at a specific time and ends at a specific time, and cannot float. It is very difficult to model a realistic day with only one type of task. With floating tasks, scripts, and other features, PEAT provides more flavors of activity than any other system. This allows more realistic daily living activities to be modeled, which is particularly important for community integration.
- Treatment Design Process
We have developed a systematic process for customizing PEAT to meet individual needs. The Treatment Guide and Workbook provides a series of worksheets that guide the process of choosing the best PEAT options for each individual.
- Personalized sounds and pictures
As mentioned above, a user's favorite recorded sounds and digital pictures can be added to the cue, name and note cards. This is a great way to customize the system and it helps to motivate the user.
We presented an overview of PEAT. There is much more that we didn't cover. A free trial is available on our website. Please visit http://www.brainaid.com for more information and to download the free trial system.
- Levinson, R. 1997, The Planning and Execution Assistant and Trainer. Journal of Head Trauma Rehabilitation, April, Aspen Press.
- Levinson, R. 1995. A Computer Model of Prefrontal Cortex Function. Annals of the New York Academy of Sciences: The Structure and Function of Prefrontal Cortex . Vol. 769.
- Levinson, R. 1994. Human Frontal Lobes and AI Planning Systems. Proceedings of the Second International Conference on AI Planning Systems. AAAI Press, Menlo Park, CA. 4. Levinson. R. U.S. Patent
numbers: 6,047,260 & 6,381, 580
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