Brain Games: How thoughtfully designed tech is addressing cognitive health

By Dave Muoio
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For as much promise as technology shows when it comes to healing the body, equally impressive is its potential for the human mind. New therapeutics and devices have shown evidence of repairing damaged nerve passageways, overcoming cognitive disorders, and simply fine-tuning the healthy brain, so it’s no surprise that innovators are rushing to bring these technologies into the mainstream.

“There are other fields where we have been literally obsessed with optimizing our abilities, like the world of physical fitness,” Dr. Adam Gazzaley, founder and executive director of the Neuroscape Lab at UCSF, cofounder of Akili Interactive Labs and Jazz Venture Partners, said during the opening keynote of CES 2018’s Digital Health Summit. “There exists specialized technologies optimizing all of these abilities … how are we doing optimizing these abilities of cognition — our attention, our perception, our memory, our emotional regulation, decision making? We are tragically lacking in those domains.”

With people now spending more and more of their time inundated with information and other digital stimuli, Gazzaley said that he sees humanity in the midst of a “cognition crisis” that is affecting how people perceive, think, feel, and make decisions. Now more than ever, he argued, it’s vital that healthcare reassert its focus on brain function and the ways in which digital technologies could help improve mental health, long-term wellness, and education.

Prior efforts to improve brain function have hit resistance from several sources, Gazzaley lamented. Small molecule treatments for mental illness generally act on the brain’s neurotransmitter systems as opposed to its underlying computation mechanisms, meaning that practitioners often have to prescribe large doses accompanied by undesired side effects to achieve meaningful success. Meanwhile, education systems worldwide often take a one-size-fits-all approach out of necessity, meaning those with learning disabilities or other conditions frequently won’t receive proper attention outside of dosing — an issue that’s only compounded by a lack of scientific understanding.

“We have very poor assessments — We don’t really know how people’s brains are functioning if they have a mental challenge,” Gazzaley said. “We don’t bring all of the amazing technologies that we use in the world of cognitive neuroscience to look at functional brain activity and understand the individual … but that doesn’t stop us from trying to improve their cognition.”

‘A new industry’

“We need other tools that are targeted, personalized, multimodal, and closed-loop, and coupled with better assessments if we are going to improve the function of something as complex as the human brain,” Gazzaley said. “How do we do that? Well, the reason I know we’re all here today is because of technology, and technology should hold that promise.”

Several new technologies, such as VR, create powerful experiences for users, and new experiences are key to brain plasticity, he explained. As such, a key opportunity lies in using technology to deliver experiences that challenge the brain and change it for the better.

Gazzaley’s research team backed up this hypothesis roughly half a decade ago with Neuroracer — a custom-built video game that was shown to improve players of all ages’ ability to multitask. Able to recognize the player’s performance and adapt appropriately to maintain the ideal level of challenge, the game’s benefits were observed to last over the course of months and spilled over into lesser improvements in working memory and attention span.

This technology and approach has since become the heart of Akili Interactive Labs’ Project: Evo. The company’s chief creative officer, Matt Omernick, also took to the CES stage to highlight the strengths of a videogame-based approach to cognitive digital therapeutics. These included their interactivity, ability to deeply engage players, capacity for constant monitoring and immediate feedback, adaptiveness, accessibility, and overall low risk compared to traditional treatments.

Akili recently announced positive results from the largest clinical trial of its pediatric ADHD-focused therapeutic. Omernick reaffirmed the company’s ongoing efforts to secure FDA clearance for the novel treatment, as well as those to continue developing games specific to other cognitive deficiencies.

“This is a new industry,” he said. “A big reason that I’m here at CES is there is now this incredible new opportunity for an entire new world for developers, healthcare providers — it’s a new industry and it’s incredibly exciting to create.”

While Gazzaley’s lab is also working on a number of different games designed to impact other aspects of cognition, as well as to include other forms of feedback such as motion capture, AR, and VR. While these have not yet been as finely tuned as Akili’s pediatric ADHD therapy, Gazzaley believes that these offerings could become a major breakthrough in cognitive wellness within the next decade.

“We don’t have this now, not in its full complexity, but I believe that this is the future about how technologies will allow us to address this cognition crisis and enhance our cognitive abilities,” he said. “When I’m asked to speak about AI, this is what I think about. This would be an AI that advances HI [human intelligence]; using this system to drive our own human intelligence to the next level.”

Education and rehabilitation

Although brain-boosting videogames were at the forefront of the Digital Health Summit, these software-driven approaches weren’t the only brain-focused technologies on display during the event.

Powered by an updated version of Google Glass, Brain Power looks to coach children and adolescents with cognitive disorders, such as autism on social cues and interactions.

“Our face is one of the most important communicative tools, the most powerful tools, we have. But many people with autism struggle to look at faces, this enormous amount of socially relevant data,” Dr. Arshya Vahabzadeh, chief medical officer at Brain Power, said during the event. “We’re using this to help guide people, in a game-like manner based on neuroscience, to help them interact with other people.”

Brain Power uses Google Glass to overlay instructions, notes, and simple games designed to help educate users on how to navigate social interactions. Alongside additional apps, a web portal, and a data-analyzing AI component, the glasses can also take wearers on a virtual tour of new environments to avoid any trauma or panic that might come with the transition. Importantly, Vahabzadeh noted, the platform helps caretakers track the user’s behaviors quantitatively.

“[The apps and web portal] records all this information, both the in-game information, the points and rewards, but also the movements and how that child is progressing,” he said. “This is one of the real tough challenges when you look at behavior: ‘How’s Johnny doing today? How was he last week?’ It’s hard for us to remember, it’s hard for us to tell, unless we have numerical reports. It cuts the workflow from the teachers and educators and parents when a system like this can autogenerate reports for them.”

Another offering, from Neofect, aims to support the central nervous system as it recovers from a debilitating stroke. The lightweight, connected RAPAEL Smart Glove fits over an arm with limited mobility, and interacts with software that uses AI and machine learning to adapt and fine tune movement challenges for the user. These take the form of games for the user to complete while monitoring mobility, reinforcing voluntary repetitions while magnifying a weakened user’s movement.

“If someone is recovering from stroke or brain injury and has upper limb dysfunction, weakness in their arm and hand, they may have the ability to start to turn on that musculature, but it might be so slight that they can’t actually use that arm in their daily routine,” Lauren Sheehan, clinical manager of Neofact USA, said during the conference. “If they can’t use the arm or hand in their daily routine, they can’t get … the number of repetitions that are required for motor relearning, so they’re really stuck.”

The RAPAEL Smart Glove has been shown to increase repetitions ten-fold, Sheehan said, and better engages the wearer during rehab sessions. The software is periodically updated with new games, and the system is ideal for clinical or home use.

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