Honours Project - Multisensory Boardgame for older people with dementia by khymsarochinee1

An Exposition submitted in fulfilment of the requirements for the degree of Bachelor of Industrial Design (Honours)

Sarochinee Teerasin S3446841 Department of Industrial Design School of Design College of Design and Social Context School of Architexture and Design RMIT Unisersity Semester 2, 2018

GRAP1040 Industrial Design Honours Part B.

Declaration I certify that except where due acknowledgement has been made, the work is that of the author alone; the work has not been submitted previously, in whole or in part, to qualify for any other academic award; the content of the exposition is the result of work which has been carried out since the official commencement date of the approved research program; any editorial work, paid or unpaid, carried out by a third party is acknowledged; and, ethics procedures and guidelines have been followed.

Sarochinee Teerasin 24 October 2018

Acknowledgement I would like to express my deepest appreciation to all those who provided me the possibility and support to complete this honour project. A sincere gratitude I give to supervisor, Dr. Juan Sanin, whose contribution in continous support and encouragement. This project would not complete without his guidance. Furthermore, I would like to thank the care profressionals from Bendigo Health who were involved in validation for the research direction. Thier vauable feedback and insights and insights have profoundly influenced on the development of this project. Lastly, I would like to thank my family and friends who have helped, encouraged and believed in me. Without your precious support it would not be possible to complete this project.

ABSTRACT One of the consequences of ageing society is increasing numbers of people suffering with dementia. People at older age are significantly at higher risk compared to the younger generation. Dementia is a substantial cause of disability and dependency among elderly people. This can be an overwhelming experience, not only for the sufferers but also their families and carers. Studies have shown symptoms of depression affecting dementia patients & their families and deteriorating their relationship. At the same time, there is growing evidence suggesting that game-based interventions can positively stimulate social interaction, reduce depression as well as improve behavioural and psychological symptoms caused by dementia for suffers and those who surround them. Memorable is a sensory board game that aims to facilitate interaction and connection between older people with dementia and everyone who provides care. Memorable creates opportunities for them to stay engaged and understand each other through sensory conversations. The game includes three different type of sensory cards, including photo cards, tactile cards, and scent cards, as a set of tools to evoke memories, emotional responses and capture the personâ&#x20AC;&#x2122;s attention. Each sensory card has a question that stimulates conversation and discussion when the game is played. This project involved different stakeholders across disciplines, including care professionals and designers. Its development worked as a platform to exchange knowledge and skills in order to deliver a design outcome that is beneficial for people living with dementia.

â&#x20AC;&#x153;Adults need to play. We are working creatures, We are bonding creatures, and we are playing creatures.â&#x20AC;? - John R. Kelly, Sociologist.

TABLE OF CONTENTS Acknowledgements

Abstract

List of Figures

List of Appendices

Introduction

Chapter 1 ‒ The Field of Design

Multi-sensory Design for Older Adults with Dementia Chapter 2 ‒ Context and Application

Multi-sensory Game for Dementia Care Chapter 3 ‒ Methods for Achieving My Design Research Project

Patient-Centred Design Chapter 4 ‒ Methods for Evaluating this Project Sensory Game Testing & Evalution

Chapter 5 ‒ Project & Prototype Development Multi-sensory Boardgame Development

Chapter 6 ‒ Project & Prototype Outcomes Memo.rable Multi-sensory Board Game

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Chapter 7 ‒ Project Reflections References

Bibliography

Apendecies

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LIST OF FIGURE Figure 1.1 — Examples of ageing vision impairment

Figure 1. 2— Sensory experiences of people with dementia map

Figure 1.3 — A theoretical model o product design for elderly

Figure 1.4 — Elements in Snoezelen sensory room

Figure 1.5 — Scent Scape Kits

Figure 1.6 — Tactile Toy Multii-coloured tangled with textures

Figure 2.1 — Positive Interaction in Dementia care

Figure 2.2 — Non-Pharmacological therapy

Figure 2.3 — THINKO

Figure 2.4 — Objects for keeping hands busy

Figure 3.1 — Bendigo Health Activity Room

Figure 3.3 — Research Synthesis

Figure 3.4 — Scenerio building

Figure 3.6 — Rapid Prototyping

Figure 3.7 — User Feedback & Evaluation

Figure 4.1 — Material Finding

Figure 4.2 — Tactile Experience Board

Figure 4.3 — User Testing

Figure 6.1 — Card Template Development

Figure 5.2 — Moodboard

Figure 5.3 — Quick & Dirty Mockups

Figure 5.4 — Idea generation sketches

Figure 5.5 — Texture Board

Figure 5.6 — Mockups for game development

Figure 5.7 — Memo.rable prototype

Figure 5.8 — Tactile Cards

Figure 5.9 — Scent Boxes

Figure 5.10 — Photo Cards

Figure 5.11 — Memo.rable Prototype 2

Figure 5.12 — Concept 2 Development

Figure 5.13 — Memo.rable prototype 3

Figure 5.14— Concept 3 Development

Figure 5.15 — Concept 3 Evaluation

Figure 5.16 — Form Development

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Figure 5.17 — Scent Container Design

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Figure 5.18 — Memo.rable Concept 3

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Figure 5.19 — Prototype Testing

105

Figure 5.29 — Tacile card

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Figure 5.30 — Template Development

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Figure 5.31 — Memo.rable concept 5 CAD

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Figure 5.32 — Memo.rable concept 5 development

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Figure 5.33 — User testing Day 2

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Figure 6.1 — Scent Card

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Figure 6.2 — Game Board

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Figure 6.3 — Game Piece witb Poraroid Photo

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Figure 6.4 — Dice Cube

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Figure 6.5 — Coloured Dice Card

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Figure 6.6 — Sensory Cards

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Figure 6.7 — Question Tag

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Figure 6.7 — Memo.rable Booklet

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A LIST OF APPENDICES Design Research Method; Guided Tour

150

Expert Interview Summary A

151

Expert Interview Summary B

152

Expert Interview Summary C

153

Design Project Summary poster

154

Persona & User Journey

155

Scenerio

156

Interaction in Dementia care Theory

157

Storyboarding based on Theory

157

User Testing Protocol

158

User Testing Feedback form sample

160

Feedback Capture Grid

162

Memo.rable User Experience Map

163

INTRODUCTION Dementia is a growing concern along with the rapid growth of aging citizens. In 2018, it is estimated that 425,416 Australian are recently living with dementia, while 250 people are joining the population with dementia each day. Over forty percent of population who have have dementia are at the age of 65 and over (Dementia facts and statistics 2018). Elderly people living with dementia are facing declines in recognization and communication with others. This condition creates a negative impact on their social interaction and maintenance of their relationship (Leisure product). Consequently, this cohort often feel isolated, lonely, bored and depressed. They are gradually losing personal interests day by day, while family members or caregivers are also into their difficult time to motivate them. In fact, there are growing evidences claim that game-based intervention can promote social interaction, reduce the person's isolation, boredom and agitation while providing benefits for cognitive training. While there are few existing products out there for people with dementia, but not many of them meets the elderly people needs. Thereafter, this design project aims to create the game to stimulate social interaction among the persons with dementia and their loved ones to improve their quality of life. This book summarises research and design processes conducted for the game development based on patient-centred design approach. An overview of the research, design development and its final outcome will be described in the last session.

... 250 PEOPLE ARE JOINING THE POPULATION WITH DEMENTIA EACH DAY." â&#x20AC;&#x201D; World Health Organization, 2018

Field of Practice

MULTI-SENSORY DESIGN FOR OLDER PEOPLE WITH DEMENTIA Introduction The word dementia derives from the Latin dis, meaning “away from”, and mens, meaning “mind”. It may describes a state of being away from memories of previous life. This can be a life-altering for both diagnosed

16 1.0

dementia, seventy-five percent were aged 75 and over. The number

MUILTI-SENSORY DESIGN FOR OLDER PEOPLE WITH DIMENTIA

of people with dementia is estimated to be rapidly escalated to

1.0

persons and their loved ones. In 2011, over 290,000 Australians had

900,000 by 2050 (Forman & Pond, 2015). Even though, there are medication treatment available for this group of diseases, many care professional associations have suggested non-pharmacological intervention as a first-line treatment for individuals with dementia . This includes multi-sensory stimulation therapy that has become popular adjunct for aged care. This chapter will discuss on the field of multi-sensory design for older adults with dementia — in both forms of product and space, principles that should be applied for making appropriate design as well as gaps that suggest possibilities of better design solution.

FIELD OF PRACTICE

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Dementia and Ageing Population Within a decade, the baby boomer generation will be labelled as “Old Age” group. In the social science, baby boomer is defined as people born between 1946 to 1964 (McFadden, 2014). It is predicted that at least 15-20% of the baby boomer cohort are likely to develop some form of cognitive impairment at some stage of their lifetime. Much attention has been directed dementia

Figure 1 — Examples of ageing vision impairment. Adapted from Designing For Alzheimer’s Disease: Strategies for creating better care environments(P.80), by E.C. Brawley, New York: Wiley. Copyright 1997 by John Wiley & Sons, Inc.

(Kanzen, 2014). Dementia as a clinical syndrome is defined as an irreversible state of progressive cognitive impairment and memory loss caused by brain diseases, most commonly Alzheimer’s disease. The cognitive impairment typically

accompanied by deterioration in emotional control, social behaviour

1.0

and motivation (Brown, 2004). Over

MUILTI-SENSORY DESIGN FOR OLDER PEOPLE WITH DIMENTIA

time, the symptoms of dementia will gradually get worse. People at the later stages of dementia will

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experience difficulties of carrying

FIELD OF PRACTICE

out everyday tasks, and will inevitably become dependent on other people. Together with age related change, the risks of sensory deprivation for individuals with dementia can be increased. This includes a reduction or a loss of sight, sound, taste, smell, or touch (Jakob & Collier, 2017). Figure 1 shows some examples of ageing vision that most of us potentially will experience as we age.

Deprivation of sensory experiences and activities may introduce challenging behaviour symptoms such as agitation, apathy, and depression as illustrated in Figure 2. Therefore, multi-sensory therapy claimed its benefits as an effective way to provide suitable level of sensory stimulation.

Figure 1. 2 â&#x20AC;&#x201D; Sensory experiences of people with dementia map

Multi-sensory therapy for dementia care

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Multi-sensory stimulation therapy was first developed for people with learning disabilities in the Netherlands in 1970s, and has become increasingly popular ever since. The multisensory stimulation usually takes place in a designated room, known as a multi-sensory stimulation room (MSSR). As mentioned previously, elder people with dementia are experiencing either sensory deprivation or excessive sensory stimulation, especially in care-home settings. The MSSR might contributes to eliminate this challenge since the space provides sensory-stimuli objects that pertain to five senses, including sight, sound, taste, smell and touch in controlled ways. The activities that happens in MSSR seems to be passive and does not limit to cognitive abilities. Therefore, it is one of the few approaches that is suitable for people with severe conditions of dementia. Based on evidences, individuals with advanced stage of dementia show the positive change in mood and behaviour (Jakob & Collier, 2014). The MSSR has been considered as nonpharmacological therapy, which offers no additional health risk compared to pharmacological treatment (Maseda et al, 2014). This is where design can be implemented to be one of dementia care strategies.

Design discourses Building on from the idea that most of people afflicted with dementia are at older age, this section explains principles that related to cognitive impaired individuals and aging population. By conducting these principles, the guardrails for design solutions are set.

Designs for Age Care Designing for older adults with dementia is different from designing for younger ones, or normal-ageing adult. Most of the older adults affected with dementia, are also affected by age-related physical changes. Considering theoretical perspectives on ageing design will cover both cognitive and physical factors. Zheng et al (2016) suggested a theoretical model of product design for elderly based on background factors, nature and characteristics as well as fundamental principles of elderlyfriendly design. The model includes the â&#x20AC;&#x153;influencing factors analysis, design theory induction and inspection & evaluationâ&#x20AC;? as demonstrated in Figure 3.

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Figure 1. 3 — A theoretical model o product design for elderly, developed by Zheng et at (2016)

The first section is to analyse

of functional design, aesthetic

background factors for determining

design, ergonomic design,

1.0

design limitations. Based on field of

structure design, and value design.

MUILTI-SENSORY DESIGN FOR OLDER PEOPLE WITH DIMENTIA

research, microcosmic factors will

While product design for elderly

be the main focus. This includes

are developed though design

analysis elder’s psychological needs

principles, it needs to be verified

which often opposed to reality. For

and improved through design

instance, there are contradictions

evaluation and user experiences.

1.0 FIELD OF PRACTICE

between elderly’s desire for healthy livings and difficulties in exercising; elderly’s desire for socialising and losses in verbalisation; and so forth. By considering these factors, there is a potential for design to minimise the challenge. The background analysis could frame a fundamental concept for a product development, generally in the areas of leisure products, home wares or health care products. With the background context and concept in mind, the analysis of design principles for elderly forms the core content in this model. This reflects in different aspects

Besides age factors, many older people living with dementia often feel and express their loss of selfhood — “ I am losing myself, one piece of mind (memory) at a time ” (McFadden, 2014). Therefore, design for empowering personhood should be addressed. Philosophers across the ages have been discussed the question of what to makes a human a person. Nancy Mace and Tom Kit wood early argued that a person is not nor should be defined by one’s disease by introducing the famous equation as follow;

The mentioned factors can worsen or ameliorate the effects of brain damage (Wayman, 2017). While personality and biography are unable to be altered and nature of the neurological impairment is either chronic or progressive, flexibility of the design will be considered to meet individual needs and suitable for specific stage of conditions. This is to ensure that a person health and wellbeing can be promoted to an appropriate level, so that the quality of life will be enhanced.

Snoezelen room Snoezelen is multi-sensory environment developed by two Dutch therapists; Jan Hulsegge and Ad Verheul in late 1970s. The initial experiment was done with a sensory tent at the DeHartenburg Institute, Holland where a set of sensory equipment such as a fan blowing, shards of paper, ink mixed with water and projected onto a screen, tactile objects, and soap and flavour foods. With positive results, Snoezelen room has spread globally in over 30 countries in past few decades. Owing to advanced technology development, the rooms currently incorporate more diverse in interactive systems and equipment, including projector, multicolored lighting, aroma diffusers, bubble tube and audio tracks to generate a relaxing atmosphere and stimulate cognitive function (Snoezelen History, n.d.) as shown in Figure 4.

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Figure 1.4 â&#x20AC;&#x201D; Elements in Snoezelen sensory room

Commercial Sensory Stimulation Product

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While multi-sensory rooms offer different sensory stimuli in designated

FIELD OF PRACTICE

spaces and most of the activities within rooms are passive, sensory stimulation products offer people with dementia a set of active activities. These actions include basic human functions such as walking, sitting moving, turning, rubbing, squeezing, pushing and so forth. The sensory stimulation objects generally take a simple form, content, texture with suitable size to avoid confusion. Colour contrast is often required to draw audienceâ&#x20AC;&#x2122;s attention. These sensory satisfying objects are commercially widespread and often used in both institutional and private care settings such as day care centre, assisted-living facilities and homes (Lucero, 2001). A number of enterprises have been developing products that claim benefits of improving quality of life for people with dementia based on multisensory stimulation approaches as given examples below.

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Figure 1.5 â&#x20AC;&#x201D; Scent Scape Kits Play the sound while smells the scents to evoke memories. The sounds of particular place and smells create authentic experiences. Available at Active Mind

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Figure 1.6 â&#x20AC;&#x201D; Tactile Toy Multii-coloured tangled with textures Available at Zest Store

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Conclusion Designing for older people with dementia is a meaningful change in care settings. Whether designing environment, products or services, the focus must be on maintaining individualâ&#x20AC;&#x2122;s abilities to live a normal life in familiar settings. It is crucial, as a designer, to understand the changes that occur from the ageing process and clinical conditions to understand special needs of individual. In this case, the need for appropriate products is clear. However, some of the given examples in this report have shown inadequate or poor designs for elderly. It has been reported that both of the equipment design and commercial goods are too childish and did not fit with original settings. As discussed in theoretical design principles for

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elderly, some of equipment does not meet physical and mental capabilities of older people. Most of the suppliers did not include reminiscent elements into the items as a part of familiarity. It was also found that there is no advice or instruction from the equipment catalogues for staffs to follow. Undoubtedly, there has been mixed successes in using these sensory equipment. To response to these design problems, the study of sensory elements including aesthetic and functional qualities must be sought. The product development should consider the way it will potentially be used by care givers and care recipients. Having equipment instructions will definitely result as effective therapeutic outcomes.

Context and Application

MULTI-SENSORY GAME FOR DEMENTIA CARE 30 Introduction Most of dementia care is provided by family members, relatives or friends at home (McCurry & Drossel, 2012). Dementia does not only affect the diagnosed person, but also everyone involved in care. Studies have shown the presence of depressive symptom in individuals with dementia and family carers. As people age, especially when experience dementia altogether, bonding moment through simple joy and interaction seem to be lost. Therefore, design intervention that targets the quality of life for care givers and their loved ones is worthwhile to consider. Some studies suggest that game-based intervention has positive impact for older people with dementia as well as the others involved in care. Mace and Rabins (1981) made four related statements about dementia journey; (1) there is damage to the brain, (2) the person is still there, (3) the family is also affected, (4) there are things we can do. While, the first two statements were discussed in the previous chapter: Field of Practice, the third and the fourth statement will be explored in this essay.

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31 2.0 MUILTI-SENSORY GAME FOR DEMENTIA CARE 2.0 CONTEXT & APPLICATION

Quality of current caregiver and care recipient relationship Caring for a person with dementia is an ongoing devotion. The responsibility of day-to-day care includes bearing the brunt of mood and behaviour changes of the diagnosed person can be a draining experience. As a result, the quality of family caregiverâ&#x20AC;&#x2122;s life becomes lower and eventually affects the care provided. McCurry and Claudia (2012) showed a clinical example to illustrate how dementia affects family, stated that:

32 2.0 MUILTI-SENSORY GAME FOR DEMENTIA CARE 2.0 CONTEXT & APPLICATION

2.0 MUILTI-SENSORY GAME FOR DEMENTIA CARE 2.0 CONTEXT & APPLICATION

“

Mr. Smith is a 69-year-old man, diagnosed 2 years ago with Alzheimer’s disease. His caregiver is his 65-year-old wife….Mr. Smith complains of feeling restless, and his wife confirms that he paces around the house, following her around as she tries to do her chores and hobbies. She also says that he has episodes of tearfulness that he finds embarrassing, and he tells her “I’m not good to anyone anymore.” Mrs. Smith herself reports frequent crying spells, disrupted sleep, weight gain, and feelings of hopelessness, largely related to the couple’s increasing isolation and to her concern about her husband, who has been resistant to her attempts to get him out of the house and doing things again (P.113-114).

“I’m not good to anyone anymore.”

This common situation in familial settings proves that both care recipient and caregiver are presenting depressive symptoms. This is commonly caused by decreases in interaction and meaningful activities. To trace this situation in depth, it can be discussed from two different perspectives of both parties. For individuals with dementia, the increase of restricted lifestyle is caused by the deterioration of physical, cognitive and communication capacity. Since the person usually concern about their changes, a common response is functioned to isolate oneself from social events to avoid humiliation, leading to further withdrawal and develop to depression (McCurry & Drossel, 2012). Likewise, for caregivers, responding to these changes requires devotion of time and exertion, resulting in social isolation along with financial stress, needs of help, emotional and physical exhaustion. Consequently, caregivers run a higher risk of having depression and anxiety. According to Brown and Hillam (2014), the prevalence of depression was found to be 26% of caregivers. Stress of caregivers undoubtedly affects care provision in many ways. The worst case probably causes a risk of abusing care recipient, both physical and emotional ways.

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Figure 2.1 â&#x20AC;&#x201D; Positive Interaction in Dementia care by Kitwood (1995)

Interaction as Dementia care

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As discussed above, lack of interaction and pleasant activities causes lower quality of life. Thus, a suitable intervention should target quality of relationship between the person with dementia and care givers. In dementia care, relationship is intimately affiliated with interaction. (Forman & Pond, 2015). Kitwood (1997) identified 10 different types of interactions based on an observation of good dementia care as illustrated in figure 1. Each one of them enhances personhood in different ways such as feelings and fostering remained abilities. promoting positive One of the most interesting areas to look at here is play, which potentially involves other interaction such as recognition, stimulation, and relaxation.. It has been claimed as a form of positive interaction that should have in good dementia care environment. This argument relates to mental health professionalsâ&#x20AC;&#x2122; statement of the three pillars of mental health, consisting of love, work, and play. Each of this interwoven field enriches one another and contributed to psychological and physical health (Schaefer, 2003).

Play Therapy By obtaining an advantage of playfulness and fun, some of behavioral problems may be avoided or diminished. Many care facilities or families devise play therapy strategy to facilitate behavioral management and enhance their interactions. Therefore, therapeutic play is not a childish pursuit, but for everyone to remain positive forces throughout our lives. Older adults with dementia have different needs in therapeutic kind of play, compared to other generations. That is to say, the requirements of strategies, forms, functions and goals are differentiated. Whereas the form of play for children often focuses on life-uncovering. Older adults with dementia need forms of play that offers different benefits such as cognitive stimulation, physical movement, sensory stimulation, reminiscence, and so forth. These can be delivered in various types of activities such as music therapy, sensory stimulation, gardening therapy, and games as shown in figure 2.

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Figure 2.2 â&#x20AC;&#x201D; Non-Pharmacological therapy Music therapy, Sensory stimulation, Gardening therapy, and Games activities

39 2.0 MUILTI-SENSORY GAME FOR DEMENTIA CARE 2.0 CONTEXT & APPLICATION

Figure 2.3 — THINKO an online platform that provide a range of games, trivia and brainteasers for people with dementia

Games for interaction Benefits of playing games are generally known for promoting socialization, c o g n i t i ve tr a i n i n g , a n d p h ys i c a l health. Games can be either solitary or played with others. (Bell et al, 2014). Many researchers suggest that keep cognitively active is good for brain health. “Use it or lose it” may become a suitable phase to this strategy. For seniors with dementia, games can evoke memories of their previous lives. Therefore, many care facilities have been adopting this as care strategy. Games and activities for people with dementia generally use remaining skills that older people still have such as intact long-term memories, conversational skills, physical skills, and familiar vocabulary (Cohen et al 2019).

Many games available in the market are not suitable for people with dementia, especially at older age. However, people across different disciplines such as care professionals, researchers and family caregivers have been developing a wide range of games and leisure products from low- to high-tech items that specifically meet the need of cognitive impairment persons. For instance, Thinko is an online platform developed by Alzheimer’s Australia NSW educators and other experts providing brain stimulation games for dementia such as puzzle, trivia and brainteasers (Dementia Australia , 2018).

Design possibilities Building on from the previous discussion of clinical example, theoretical aspects of positive interaction and play therapy, implies opportunities to develop new forms of game for dementia care. Based on research, there are much fewer products that focus on a social dimension for older adults with dementia, compared to the products that focus on individual tasks such as keeping-hands-busy items as shown in figure 4. Therefore, this project aims to explore design possibilities to develop new forms of game that mainly enhance interpersonal skill based on the theory of personhood and play therapy. From this purpose, it creates opportunity to involve family members from different generations and feel connected again. That is to say, the game itself would not create a joyful experience without the right persons to interact with. Especially for young children who often never failed to bring the laughter and it reminds us of the brighter day (Wayman et al, 2017). Besides the focus on familial context, the game-base design intervention can be used in care facilities. This allows staffs to gain more knowledge of patientsâ&#x20AC;&#x2122; inner experiences and their perceptions (Van et al, 2010). Moreover, the game itself can be used as an incentive for visits since it can be used as a tool to facilitate visitors to communicate with the patients, in both verbal and non-verbal ways.

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Figure 2.4 â&#x20AC;&#x201D; Objects for keeping hands busy, especially beneficial to those with dementia

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Conclusion Human, as a social being, is always in relationship with others owing to people needs of connection and intimacy. The older adults with dementia are often perceived as less behaving, thus they are not in need of social interaction. In fact, the desire of socially engaging with others still remains, even if cognitive and physical abilities decline. It is clear that care givers and the older adults with dementia just want to be normal in their later lives. To alter theses overwhelming negative experiences, the design intervention that recalls positive experience is needed. Game, in this case, is not used to pass the time but for evoking memories, building relationship, and more importantly, to remind them that all the laughter and joyful moments are still there to experience despite dementia. The design will be developed by investigating

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and identifying needs and satisfactions of the persons with dementia and their loved ones. All the methods used for a product design development will be explained in the next chapter.

Project Design Methods

PATIENT-CENTRED DESIGN Introduction Most of dementia care is provided by family members, relatives or friends at home (McCurry & Drossel, 2012). Dementia does not only affect the diagnosed person, but also everyone involved in care. Studies have shown the presence of depressive symptom in individuals with dementia and family carers. As people age, especially when experience dementia altogether, bonding moment through simple joy and interaction seem to be lost. Therefore, design intervention that targets the quality of life for care givers and their loved ones is worthwhile to consider. Some studies suggest that game-based intervention has positive impact for older people with dementia as well as the others involved in care. Mace and Rabins (1981) made four related statements about dementia journey; (1) there is damage to the brain, (2) the person is still there, (3) the family is also affected, (4) there are things we can do. While, the first two statements were discussed in the previous chapter: Field of Practice, the third and the fourth statement will be explored in this essay.

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47 3.0 PATIENTCENTRED DESIGN 3.0 PROJECT DESIGN METHODS

Figure 3.1 â&#x20AC;&#x201D; Bendigo Health Activity Room

Patient-Centred Design Patient-centred design is a new interdisciplinary term used in clinical practice. The process as its greatest potential requires a profound understanding by both design and medical professionals. Patient-centred design can be referred to the process of design for products, processes, or environments used by patients. Similar to universal design and user-centred design (UCD), patients are typically put at the heart of processes, products and environments. While universal design aims to serve both impaired and nonimpaired people and user-centred design (UCD) aims to increase the participation of user in design process. Patient-centred design is highly complex form of the UCD approach since it is specifically for patient, defined as the person who has health condition or in health-related settings. A great challenge in conducting patient-centred design approach is to work in interdisciplinary team and bring out interdisciplinary research. Typically, medical professional focus in the area of physiology or anatomy of the patient and pay less attention to the patientâ&#x20AC;&#x2122;s surroundings. As opposed to medical professionals, designer of health-related products or services focus on the point of interface of the patient with the environment. By sharing the same interest of improving patientsâ&#x20AC;&#x2122; quality of life, professional skills and knowledge from both health care and design fields are merged. An outcome from the shared perspectives of multiple individuals including patient is eventually tested, evaluated and revised to meet the most of patientâ&#x20AC;&#x2122;s needs and desires.

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Secondary Research To understand the context at early stage, secondary research is explored in the field of health care practice to understand context surrounding the issue that was initially proposed. In this case, the context is focused on designing for people with dementia. Literature search, including books, academic and media platforms, is used to study the information that is already investigated. The tool helps to reassure that an initial idea of the design project is relevant to current situation of the real world. Since this project aims to create a healthcare product for commercial purpose, market research is conducted. Comparing the existing products in terms of form, function, material, price, and purpose help to identify gaps in the market and opportunities for design prepositions. Based on collected data, a brainstorm map is created to highlight out key findings and interesting

50 Figure 3.2 â&#x20AC;&#x201D; Expert Evaluation

Discover insights Besides secondary research, there are few methods that are used to obtain insights from primary research. By collaborating with Bendigo Health, guided tour was conducted early in this project. This method allows designers to go into the context and to experience the environment firsthand. Immersion is one of great primary ways to understand the target group of the design project (DesignKit, 2018). Photos of care environment, particularly multi-sensory room, and therapeutic products that normally used by staffs and patients, were taken as a part of research tool. As there is a limitation in the primary research methods, initial user observations was unable to be implemented. However, an expert interview was conducted throughout the research and development stages. In this case, care professional are experts in interacting with older people with dementia. The experts have been trained and provided care as well as pleasurable activities to the patients in regular basis. Therefore, gaining an in-depth understanding of cognitive impaired individuals and technical information are achievable. (Van et al,2010). As a probe, questionaire pamphlets were prepared and left to the care professionals at the day of visit. The 2 pages of A4 provided background information about the design project and lists of questions for occupational therapists to freely fill in.

3.0 PATIENTCENTRED DESIGN 3.0 PROJECT DESIGN METHODS

Map insights The information from observation, guided tour and expert interviews were gathered and mapped to review and analyse. This method helps to identify opportunities and define focusing area. The review includes data form note-taking and photographs. As this stage, conducting further research might be required if some gaps are found and need to be filled (Eikhaug, 2012). The findings were organised into categories to easily eliminate irrelevant information. While some ideas started to resemble each other into categories, some irrelevant information was eliminated. Comparing insight map to secondary research map was done to find common themes or use as evidences to support other ideas. This process allows designers to rephrase the primary research question if necessary. At the end of this method, new discoveries were found. Evidence-based information of target group has become more robust. As a result, the process uncovered issues, problems and existing solutions that can be used as a starting point to set possible design directions.

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Figure 3.3 â&#x20AC;&#x201D; Research Synthesis

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Design briefs Design brief is required to be addressed for choosing directions with the most potential for the challenge to overcome (Eikhaug, 2012). Based on initial project goals and missions, the design brief was translated from evidence-base generated from exploration phases. The most crucial part in this process is to create success criteria. Building a list of criteria for the design brief assists in evaluation and idea selection for design outcomes. As a result, one specific brief was selected to explore different creative directions within selected context and application. This process is generally a traditional starting point of development process (Eikhaug, 2012). The patient-centred evidence-base supports a solid foundation of the design brief.

Scenario building Scenario provides realistic examples of how users feel, behave and interact in specific context. Building scenario primarily aims to visualise examples of future use to understand user requirements, needs and aspirations (Damodaran, 2001). Typically, this process is used by designers to consider characteristics of intended users as well as their tasks and their environments. It can be implemented through user profiles, personas, storyboarding and role-play (Eikhaug, 2012).

For this design project, personas and storyboarding were used as selected tools. Persona generates fictional characters based on the field of research to represent different user types that potentially involved in products or services. Designers often adopted this method as a guide for ideation sessions. Based on persona profiles, storyboarding was visualised different scenarios to explore the idea in context by sketching out as sequences of user actions in the chosen environment.

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Figure 3.4 â&#x20AC;&#x201D; Scenerio building

Define design principle Design principles are created to codify and formalise design process in order to solve future design problems (Fu et al, 2015). Determining design principles for the project is to build the guardrails of design solution. It points out the most important elements that must be involved in design outcomes from key aspects. This process is revisable as prototypes and ideas are tested in development stage. In this project, key design principles focus on the design principles to accommodate older adults with dementia.

Material exploration Material exploration is one of the most important processes of this project. Since the design objective is to create multi-sensory stimulation for the persons with dementia, materials become crucial for the foundation of object designs. With the focus on visual and tactile experiences of the patients, different materials have been collected. The swatches of materials are display on the large board in order to facilitate an analysis of suitable materials that will be used in prototypes and final products. Moreover, other materials that stimulate other senses such as sound and smell may potentially be explored in this project altogether. The criteria of choosing which materials are based on research evidence and care professional suggestions.

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Figure 3.5 â&#x20AC;&#x201D; Material Exploration

Rapid prototypes Refer to human-centred design approach; rapid prototype is one of the most effective way to make ideas more tangible and able to be quickly tested. This facilitates quick feedback from target user and experts from the early stage (DesignKit, 2018). A number of prototypes are created to convey ideas. Therefore, the quality of the prototypes is disregarded to move through multiple iterations.

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User feedback & evaluation Evaluation with the target group happens iteratively throughout the development process (Eikhaug, 2012). Once the concepts are developed into realistic solutions, collecting feedback on the design ideas and prototype is a key element to keep potential users at the centre of the design project. The prototypes and mockups are proposed to test in a real context. In this case, iterative feedback from care professional in Bendigo Health is expected as well as from the family carers. To test the ideas and prototype with a range of users is to verify design solutions, record initial market reaction and test the details, usability and features before production (Eikhaug, 2012). Time will be leaved within the overall process to allow the final adjustments to the design based on user feedback.

PROJECT DESIGN METHODS

Figure 3.6 â&#x20AC;&#x201D; Rapid Prototyping

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Figure 3.7 â&#x20AC;&#x201D; User Feedback & Evaluation

Research methods and iteration Most of the design methods discussed earlier will be reused throughout the design process. However, the difference is the focus. Some research methods such as expert interview, map insight, and material exploration are not used to discover insights or explore in general context, but to evaluate design concepts from user feedbacks. This method will help to deliver a more market-ready outcome from an on-going consideration as well as correct on early failings in redesigning phase.

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Conclusion Design can be defined as a process of investigating a problem and creating a solution. Patient-centred design brings patients perspectives to that problem and inspires different viewpoints of individuals. Design teams, care professionals, researchers and family typically work across disciplines in close collaboration to identify needs and satisfactions of the patients. That is to say, the potential outcomes will be more varied, innovative and patient-friendly. The new valuable design solutions are brought to the familiar challenge in order to help people with health conditions to live a better life.

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M e t h o d s o f Te s t i n g , E v a l u a t i o n a n d v a l i d a t i o n

SENSORY GAME TESTING & EVALUATION Introduction

Commonly in design process, testing is conducted to obtain feedback on design solutions from users. Then, utilising that feedback to improve and refine the solutions. It is an iterative process that helps designers to continue learning and building empathy with their target users. Different stakeholders were involved in this process, including design professionals, care professionals, and target users. Low-resolution prototypes have been the key artifacts involved in each testing session throughout this project. Each of method used for testing, evaluation and validation and its outcomes will be discussed.

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Methods 1: Prototype for empathy (Texture board/ Initial mockup) Generally, prototype is built to test with users to evaluate design solutions and to build more empathetic understandings. Early prototype for this project, however, specially created to gain empathy without testing solution at all. This method is also known as “active empathy” since it creates conditions that brings out new information. That is to say prototypes for empty help designer to gain initial understanding about the design concept together with user mindsets about particular issue.

Limitation

Few prototypes for empathy were created to understand the experience that the target group has been through.

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However, the perception of the experience may not always be similar. Since the target group for this

SENSORY GAME TESTING & EVALUATION

project is the older adults with cognitive impairment,

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the prototypes for empathy used in this project will

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eventually be validated with care professional once again to test the effectiveness.

Figure 4.1 — Material Finding

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Figure 4.2 â&#x20AC;&#x201D; Tactile Experience Board

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Outcome As mentioned previously, elderly with dementia are suffering from sensory deprivation and cognitive condition. With this in mind, the very first sensory board was created to experiment sensory experience. This method improves an

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understanding of how people with sensory

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deprivation can connect the world through different stimuli. The outcomes from this mockup had influenced the design direction.

Methods 2: Expert evaluation Care professionals are expert in interacting with people living with dementia. Therefore, get feedback from them were valuable in affirming and refining the design direction. In this project, the intention of expert evaluation is validate the idea of the game, including a game strategy, material, form, size, and colour. The session was conducted offsite with care professionals from Bendigo Health.

Limitation Since new prototypes are developed after each evaluation, feedbacks from experts could be difficult to gather because it may be hard to arrange time with care professional due to distance and availability. Therefore, some prototype has to develop further based on feedback from other people or based on clinical case studies.

Outcome Some sketches and mood-board were presented to back up a low resolution prototypes, as shown in figure â&#x20AC;Ś These enabled care professional to quickly understand the concept and instantly give opinions and suggestions on concept and design direction. Note taking is used to collect all feedback.

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" Does it necessary need a start to a finish point, how long is a suitable length?" However, some questions regarding duration of the game were raised. "Does it necessary need a start to a finish point, how long is a suitable lenght?". The discussion was gone on among the design team and care professional team. It was suggested that instead of having a start to end point, it might be another way to try to play game in a loop and let the group decide when the loop should be ended. The reason

was given that the main purpose of the game is to share experiences and thoughts through conversation.

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â&#x20AC;&#x153; Because some families are really struggling to initiate conversation. I think this will be a good tool for them â&#x20AC;?

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Figure 4.3 â&#x20AC;&#x201D; User Testing

Method 3: User testing While design and care professionals had been participated in user testing for a few times. The feedback may gradually base on their familiarity of the project. Having the prototype testing with lead users who have never seen the product before can bring fresh opinions to the design. Lead users often bring out a user perspective on a full range of design, which includes aesthetic, function, ergonomics, user-friendliness and many more. But

most importantly, testing a product with lead users in

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unexpected idea adding a robustness to the design

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approach (Eikhaug,2012).

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is to understand whether users can successfully

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understand the game based on information provided,

a real-world scenarios will encourage them to bring

Key objectives for user testing for Memo.rable game

and to investigate how much the game can facilitates their abilities and conversations.

Limitation Initially, the user testing aimed to include occupational therapist and people with cognitive impairment in the test and expected to be conduct earlier. Unfortunately, due to the delay of ethic application and few other issues, the first testing plan had to be cancelled. Therefore, the plan was altered to test with people with similar characters, who are people at older age living with their family.

Outcome The testing was held in 2 sessions in 2 different days with the focus of family context in a group session by involving at least one older adult in at the age of 55 and over. The approximate length of testing is between 45 60 minutes, facilitated by the moderator. In the beginning of the session, participants were welcome and inform briefly about activities that needed to be done for the session. Each participants received user guides

that contains information about game, game instruction, and personalisation guide. Moderator was responsible

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to demonstrate how the game can be played. Lead users were encouraged to give verbal feedback after each

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task completed to give instant responses and opinions.

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At the end of the session, family members were asked

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to evaluate the overall post-game experience by using a feedback form.

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Method 4: Feedback capture grid Feedback Capture Grid is also another method accommodated user testing. While feedback form contained well-structured questions, feedback capture grid was used to facilitate real-time capture feedback from users systematically, or after the test when needed to organising the various feedbacks you have gathered. To start using Feedback Capture Grid, divide a sheet of paper into quadrants. Draw the top left a plus to capture

things that users like the most. Draw a triangle on the

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top right to for things that could be improved. Draw

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question marks on the bottom left to for things users donâ&#x20AC;&#x2122;t understand. Lastly, draw a bulb on the bottom right for the new ideas to consider.

Limitation Supposedly receiving overwhelming number feedbacks from user, it might be difficult to note everything down right at the spot, particularly when the testing was done in a group. However, voice recorder can be used to record user feedback and re-access to organise them into the grids later.

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Figure 4.3 â&#x20AC;&#x201D; Feedback Capture Grid

Project & Prototype Development

MULTI-SENSORY GAME DEVELOPMENT Introduction Memo.rable project has embraced the iterative design process since the start. It is a simple concept of identifying a user need through user research and generating ideas that meet their needs. Selecting one best idea to develop a prototype. Then testing the prototype that demonstrated design solution with users to get feedback. From the information the user gave back during testing was used as a guideline to amend the design. By following that, a new prototype is created and begins the process all over again until the design solution find the right tune with the target user. So, this chapter is dedicated to show an overview of the outcomes from iterative design processes and its journey.

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Figure 5.1 â&#x20AC;&#x201D; Card Template Development

Initial idea The initial goal of this design project was to seek for opportunities to facilitate interaction between older adults with dementia with and those who surrounding them through a meaningful activity, particularly kitbased activity. The project outline explained those statement in depth, was brought to the very first expert interview in Bendigo Health. With suggestions from occupational therapists, three possible design directions was generated, which are Craft for reminiscence, Physical exercise for sensory stimulation, and Game that enhance sensory experience and evoke memories.

Traditional game + Sensory stimulation As mentioned in previous chapters, there are growing evidences suggest that traditional games offer people with dementia a cognitive training and promote social interaction. These games are also considered as one of popular leisure activities in care settings. With this in mind, the project started to explore how traditional game can be developed to deliver higher sensory experience for older adults.

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Figure 5.2 — Moodboard

Figure 5.3 — Quick & Dirty Mockups

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Figure 5.4 â&#x20AC;&#x201D; Idea generation sketches

The sketches quickly visualised the idea from mind onto paper for eyes to see. However, it is also a different story in this case since sensory experience had been a main focus. To build up an empathy with users, the texture board was created to explore a different sensory experience and also to facilitate feedback from experts.

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Figure 5.5 â&#x20AC;&#x201D; Texture Board

The feedback included which material on the board should be considered as well as which material should be avoided. From that list, quick and dirty mockups of sensory traditional game were created for experimenting.

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Figure 5.6 â&#x20AC;&#x201D; Mockups for game development

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Board Game Development After testing mockups, however, these form of games still limited in interaction. This is the point where the project shifted from one-on-one activity to an activity that involved more than one person. In other word, the required number of participants became unlimited as long as there are interactions happening between the persons with dementia and anyone surrounding them. These are few more brainstorming and sketching to pursue the new ideas. The concept of having a board game with multi-sensory stimulation was considered to be the most promising one. Nonetheless, the intention of developing from. traditional game was still remained.

Memo.rable Concept 1 â&#x20AC;&#x201D; Demonstrate the concept design The traditional game, snake & Ladder, was selected to develop into a multi-sensory board games. Three types of sensory stimuli were selected which included visual, tactile and smell experiences. The way of playing game was the same as Snakes & Ladder with a bit of a tweak. Roll the dice and move the game counter forward the number shown on the dice. If the player lands at the bottom of a ladder, the player can move up the top. The player has to play with the assigned sensory box based on its colour. For example, if the player lands on the yellow space, the player has to pick up a sensory object from the yellow box. It was only rough concept with the main focus on the type of game and which sensory stimuli that were included.

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Figure 5.7 â&#x20AC;&#x201D; Memo.rable prototype 1

Figure 5.8 — Tactile Cards

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Figure 5.9 — Scent Boxes

Figure 5.10 — Photo Cards

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Feedback for further development

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The traditional game, snake & Ladder, was selected to develop into a multi-sensory The concept was good to continue. However, there was still a few points to develop, test and validate. Firstly, think about how the persons can play with these sensory kits and how they will be implemented, when and where is this going to be used. Secondly, the design should not be timely. In other word, it should allow people from any generation to play this game. Therefore, personalisation was worth considered to include in the game.

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Memo.rable Concept 2 â&#x20AC;&#x201D; Coloured dice card, dice cube, tactile box and mission cards. In the second prototype, the game board rule was still remained. The number dice cards was replaced with colour ones and a dice cube was added. The dice cards were used to navigate the direction. While the dice cube was trolled to select the sensory game. Another thing that added on was an object box and a set of mission card for tactile stimuli. Selected scents were contained in a small jar by using aroma oil and cotton. The photo cards were as same as the previous design.

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Figure 5.11 â&#x20AC;&#x201D; Memo.rable Prototype 2

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Guess The Smell

Story time

Mission card

Guess The Smell

Story time

Figure 5.12 â&#x20AC;&#x201D; Concept 2 Development

Mission card

Feedback for further development

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Something people usually have in the morning

Pick one object from the mistery box Move one step forward if the object begin with â&#x20AC;&#x2DC;Bâ&#x20AC;&#x2122;

MISSION CARD

Move one step backward if one person in a group had a pet before

MISSION CARD

move forward one step if you guess the smell right

It was believed that dice card could be beneficial in the game in term of cognitive training. Even when the game is not going to play in a full set. The card itself can be use separately as a matching game. However, there were some significant feedback on making all the elements in the same language since there were too many form, including 3 three different kind of cards, cube, box, and jar. The design of game board also required for further development as well as its colour shape and size.

Memo.rable Concept 3 â&#x20AC;&#x201D; Organic shape, bigger game board, smaller dice card, sensory envelops, photo card. For the third prototype, the various forms in previous design were minimised. The object box and mission cards were replaced by tactile envelop. The scent jars were changed to scent bag in each envelope. Most of material used was paper. Each sensory was used to facilitate the response from the question on each envelope.

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Figure 5.13 â&#x20AC;&#x201D; Memo.rable prototype 3

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Figure 5.14â&#x20AC;&#x201D; Concept 3 Development

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Feedback for further development

The design and game instruction should be remained as it is. There should not restricted to any particular theme, keep it generic and open. Maybe it was not necessary to have start and end points. It could possibly be a loop since the main focus was to have a conversation. Just like talking, we can decide when the discussion should be ended in each session.

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Figure 5.15 â&#x20AC;&#x201D; Concept 3 Evaluation

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Figure 5.16 â&#x20AC;&#x201D; Form Development

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Memo.rable Concept 4 â&#x20AC;&#x201D; A board game of sensory cards From from the third prototype to the fourth one, it had been accelerated in form exploration. The focus was mainly on what sort of final form should it be?, what material should be used. The most challenging is how the scent can be delivered. This was where this project was out of the track. The focus was heavily on the scent. As a result many forms of scent container were created and somehow it went back to a concept of jar that has previously explored. However, the project was suggested to be simplified.

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Figure 5.17 â&#x20AC;&#x201D; Scent Container Design

From that point, the paper become the main material. All sensory objects were translated into a form of playing cards to reduce the cost and promote the sense of board game. Some of the sensory cards provided in the box were pre-made and some were provided as a template. All components were designed to be oversized to accommodate older adultsâ&#x20AC;&#x2122; abilities.

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Figure 5.18 â&#x20AC;&#x201D; Memo.rable Concept 3

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Figure 5.19 â&#x20AC;&#x201D; Prototype Testing

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Figure 5.29 â&#x20AC;&#x201D; Tacile card

Feedback for further development The pre-made sensory cards, especially the tactile cards, are too complicated when it needs to be produced in a larger scale. The given sensory objects would not be relatable for anyone when everyone has unique life story, even for the same topic.

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Figure 5.30 â&#x20AC;&#x201D; Template Development

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Memo.rable Concept 5 â&#x20AC;&#x201D; User testing prototype, from ready-toplay game to game template The final concept of Memo.rable is to provide family a game with sensory card templates for family to fill their personal sensory in. This prototype had the greatest change amongst all, based on all previous feedback together. The board had changed into a loop. The colour theme is changed to be more vibrant for old-aged eyes. Everything was still designed to be oversized. The game piece can be with the name tag or Polaroid photo. The full set of game was created to test with older adults and their family.

Figure 5.31 â&#x20AC;&#x201D; Memo.rable concept 5 CAD

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Figure 5.32â&#x20AC;&#x201D; Memo.rable concept 5development

Feedback for further development Overall impression still vary from somewhat negative to positive. To get people to understand of how the game is played. User manual seems to be a suitable deliverable for only younger ones. While the older adults seemed to have less interested and motivation to read out and interpret it by themselves. Demonstrating is the first preference to learn about the game rather than explaining or reading, respectively. Keep playing repeatedly help the person to understand the game more as they go. At this stage, the most common confusion found was a navigation on of the game board: ‘Is it clockwise or anti-clockwise?’. Sensory stimuli on each card effectively capture people attention. Every participant was excited to touch, smell and look at the photo and keep interacting with an object for a few seconds before pay attention to the question tag.

"Is it clockwise, or anti-clockwise?"

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Figure 5.33 — User testing Day 2

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â&#x20AC;&#x153; I think you explain this to me might be easier. The text is too small I can't read." Another significant point that was validated in the session was the personalised sensory card. It had shown more engaging respond when they picked up the card that directly related to their lives. For instance, there was a neutral response when they picked up the card with random photo . While on another round, they picked up the photo card that showed their own photo, it significantly excited them and started to discuss more on the given topic while keep holding the card with them.

114 At the end of the session, few considerations from users had raised, including What if the player cannot recall those related memories. What if they can no longer communicate. Can one question open up other people too? Do we have to do this to have a conversation?. These questions can be used for a guideline to improve the information on the user manual.

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Figure 5.33 â&#x20AC;&#x201D; User testing Day 1

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Conclusion The iterative design process had created a long journey for the product development. However, it is worthwhile in order to deliver the final outcome that meets the user needs. Consistently getting feedback has driven the design project on a right track while keeping the older adults with dementia right at the centred. Surprisingly, the feedback from user testing before developing the final outcome had added robustness to the design. It had validated the objective and also suggest a few last design adjustment for the final product, which will be discussed in the next chapter.

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Project & Prototype Outcome

MULTISENSORY BOARD GAME: MEMO.RABLE Introduction There have been several goals and opportunities that influenced the development of Memo.rable. From the goal of seeking for opportunity to design a kit-based activity to promote social interaction for older adult with dementia and everyone involved in care, to where the project aim to create a game template that allows family and carers to tailor an activity for their loved one so that they can create their own language to the game. This chapter will explain Memo.rable project as a final outcome in in details, including what Memo.rable; what is its impact as a therapy and how does it work.

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About memo.rable Memo.rable is a multisensory board game specially designed for elderly people with dementia as well as everyone who provide care. The board game creates opportunities for social interaction and helps older adults with dementia stay engaged in meaningful conversations despite the progression of dementia. This is a great inter-generation tool to offer an enjoyable moment within families.

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â&#x20AC;&#x153; This creates hope for me, and I think for other families, too. I would feel so loved when someone care so much about me and they do all of this to ensure that someone will provide me a right care when they (her children) can not be with me all the time. " - Feedback for usertesting participant

PROJECT & PROTOTYPE OUTCOME

Figure 6.1 â&#x20AC;&#x201D; Scent Card

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How does it work? Memo.rable board game is a noncompetitive game, where everyone is the winner of being an expert of their own. The game consists of a colorful board with three different categories of sensory stimulation. The stimuli include tactile card, scent card, and photo card. Players draw a colour dice card from the pile and move the game counter to the corresponding color on the board. If the player land on the space without cube icon, stay and wait until the next round. Conversely, if the player land on the space where there is a cube icon, the player has to roll dice cube to select the playing sensory cards. Each sensory card has a personal sensory object including personal photo, objects, and scent, which would have been previously crafted by family, friends or caregivers by using the template provided on the box. The question tag located below the sensory swatch on the same side of card. At the front of each question tag is a title of each sensory, slide the card out and read the question from the back. The sensory card works similarly to a flash card as a conversation facilitator, but with higher sensory experience.

Whatâ&#x20AC;&#x2122;s in the box?

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Figure 6.2 â&#x20AC;&#x201D; Game Board

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A game board A colourful game board was designed to be as simple as possible and crease in its contrast. The playing areas require standing out from the background. All visual clutter and unnecessary graphic is intentionally avoided to reduce a likelihood of confusion. Bright and vibrant colour are used to facilitate visual presentation based on design principles to accommodate age-related visual impairments will increase perceptibility for people of any age.

A game piece The game piece consists of 2 part; the wooden base with a slot and the personal tag. For the personal tag can be created by insert the nametag provided in the box and write the player name down, preferably using pencil that is also provided in the box. Alternatively, the 85x55 Polaroid photo can also be used to insert on the wooden piece as well. This is to create senses of belonging and reduce a frustration of trying to remember which game piece they use.

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Figure 6.3 â&#x20AC;&#x201D; Game PiecewitbPoraroid Photo

A dice cube A dice cube is rolled when the player step on the space with icon cube. Each facet will indicate which category the player needs to draw from its pile. Like other components, it simply indicates by the text and the boarder colour on each facet. For example, if the dice cube is rolled and stopped on the side of ‘Photo card’ with yellow boarder, the Photo card with the same colour has to be picked.

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Figure 6.4 — Dice Cube

A dice cube A set of colourful dice card is used to navigate each game piece. The matching method quickly stimulates the person brain while run the game instantly without costing.

Figure 6.5 — Coloured Dice Card

Sensory card Each sensory card comes with a question tag that is either the one comes with the box or the one created by users. It is the main activity of the game that to encourage persons with dementia who are losing short term memories to reminice and discuss past and present interes through different sensory experiences. There are three categories as followings;

Tactile card Tactile card offers player sensory experience through touch. The texture can be made by bringing personal object or craft, then use adhesive to stick one the template provided. The overall size of the template is 100x100xmm. However, the dedicated space for texture craft is 90x90mm, which also indicate on the template.

Photo card Photo card offer connect the player with their memories or world surrounding them through visual. This is the simplest way to personalised compare to other categories. Simply print out personal photos in the size of 100x100mm that also considered as a stand size that available to print out from any photo printing place, or simply print at home.

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Figure 6.6 — Sensory Cards

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Figure 6.7 — Question Tag

Booklets There 2 booklets provided in this design. The first one, About Memo.rable, is a user manual that contains pages of user guideline, game instruction, and personalisation guide, for users to follow. The second booklet is a Collected Memories book that is the personâ&#x20AC;&#x2122;s biography book, used as a post-game form to note down all stories, thoughts and preferences the person shared during the game.

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Figure 6.7 â&#x20AC;&#x201D; Memo.rable Booklet

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General Impact The Memo.rable game generally facilitates visits, initiate conversation through sensory cards, and provides the personâ&#x20AC;&#x2122;s biography, written down on a given booklet by the host of the game It is served for a dual purpose. Firstly, it allows the family to take what they already know about the persons to the game. Secondly, it also serves as a tool to collect new information about persons. It is believed that trust and communication are enhanced when family members or caregivers recognise the persons as who they are by understanding their personality, personal history, family background, values, hobbies, interests, and much more. The memo.rable game are an incentive for visits, involved family in its production and gathering intergeneration members together which appears to have a positive impact on reducing grief of feeling helplessness. The game also increases staff interest to provide care and to understand one another. Those mentioned positive impacts could be delivered in lower budget design intervention.

Impact as a Therapy

Impact on the older adults with dementia As generally known, people associated with memory problem tend to repeat same story overtime. This reveals their preserved memory that allows families to explore in a greater depth or other memories associated with the repeated stories. The collected information can translate into the content of the game. One sensory story can possibly lead to one another. That is how the personâ&#x20AC;&#x2122;s biography can build up.

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Figure 6.8 â&#x20AC;&#x201D; Photo Card

PROJECT & PROTOTYPE OUTCOME

Impact within family

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Based on studies in similar cases, this kind of biography-building tools can be therapeutic for families as well. The game requires to pre-make individualised cards and assemble in order to produce the personâ&#x20AC;&#x2122;s biography in a form of game. Younger members are encouraged to participant in a making and playing phases to warm up the environment with their youthful interaction. Everyone can enjoy the quality time while the game is played, either being part of the game or sitting aside watching. It enhances the feeling of normalisation in humanistic way. Based on user feedback, it also provokes a positive for the players in the context of family gathering. All these steps empower the family caregivers that they can make difference for their loved one. By providing a new way of assist their loved one and be the main part of its production can alleviate their anguish and frustration.

Within care settings Based on studies in similar cases, this kind of biography-building tools A number of studies reveal that people with dementia prefer to stay in their own resident with his or her family as long as they can, even though they know that they will eventually be institutionalised. This indicate that older adults with dementia mostly moved to other care settings when the progression of dementia gets worst, which means when they had very little abilities to communicate and do tasks by themselves. Typically, the person’s one-page life story was discussed by staff and used by staffs in the nursing home, which does not include a life story (cite : the first..). In contrast, the post-game form booklet provided in a game offers the person’s biographies that had collected by family. the biography booklet can be passed to the care professionals and staffs. It offers opportunity to improve caregiver’s knowledge and understanding about the person. There are evidences proved that the provision of their biographies can make a greater difference on how the persons with dementia are recognized and understood, especially in the later stage (the first therapeutic game). Integration between people are significantly influenced by what they are know about one another (Cite first) It becomes therapeutic tool to some extent in improving communication between the person with dementia and staff in care settings by providing an accessible person background information.

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Conclusion Memo.rable multi-sensory board game offer flexible ways of using and playing. It is a great inter-generation game that can be played at any where with anyone as desire. Either play it at home with family members or at hospital with caregivers or even with visitors, it still provides a quality time of the day. Based on feedback from user, Memo.rable tend to create a morale for a family. Some people love to talk, some people might just enjoy sitting aside and listen to all conversation shared from their loved ones. Either way, it also become another platform that for family to gather and build up understandings of each other. Last but not least, Memo.erable game aims to evoke past experiences and memories. At the same it also creates new memories each time it is played.

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Methods.....

REFLECTION Introduction Most of my previous design projects were emphasised so much on its aesthetic and materials. Memo.rable is the first design project that I worked in a context of design for health and wellbeing. It offered me a chance to explore new ways of working as a designer. Firstly, the target group in this project is an extreme user. They have quite a few limitations, both psychologically and physically. Therefore, it has been a good practice of putting people at the centre throughout the design process. Since I have never interacted with people with dementia before, empathy for the users were built effectively by talking to their relatives and from case studies. Involving different stakeholders, especially care professional from Bendigo health, had provided valuable feedbacks that influenced the design to be more practical and less subjective. Moreover, the iterative design process had significantly shifted this design project from point zero to the point where everyone satisfied with the design outcome. The process showed endless potential for the design development and helped to decide where to stop and refine.

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The challenges I have faced and how did I overcome it

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It was not easy to design for people with health condition, especially for people with cognitive impairment. The limitation of implementing user research had become the most challenging part of the project. It was almost impossible to work directly with them due to ethical aspects and other related issues. Therefore, it was difficult to discover user insights in order to develop a right product that they need. The best solution was to work with an experts who has been interacting with them on day-to-day basis. However, the user testing with people with dementia was still expected to happen while waiting for ethic application to approved. A number of user testing protocols had created, edited and changed for an approval of the application. Unfortunately, the user testing had been postponed for months and eventually halted. This situation is ,somehow, predictable when it was reaching its timeline. Hence, the fallback for this predictable situation was to test with people who have similar characteristic. In this case, elderly people who still living in their family. Surprisingly, the feedbacks that were received from the user testing were very useful. Even if they do not have a cognitive impairment condition, but age-related changes also have them in similar limitations.

What do I wish if I had spent more time on or done it differently. If I had more time on Memo.rable project, I would like to extend the experience around the product. Memo.rable is a board game that offers templates for families and carers to fill personal sensory objects in. However, the template offered is still in an limited number. Even they can duplicate the template by using their own material, following the user guide, there still are too many steps required. Therefore, if I had more time to spent on the project, I would create an online platform for Memo.rable users to print out extra templates when required, or it can also be a platform to share their own experiences and tips about the game. There are many possible ways to do when thereâ&#x20AC;&#x2122;s an extra time. However, the project has already achieved its goal.

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Conclusion There is a clear evidence of needs for more leisure product for seniors with dementia. Thereafter, Memo.rable aimed to make a multisensory board game where everyone can put their sensory objects that related to personal interests as an input for the game. The design prototype had tested for several times to make amendment to its functionality and its appearance. The final version of the game has simplified to meet senior with dementiaâ&#x20AC;&#x2122;s cognitive abilities, while oversized components are to accomodate their physical ability. According to user feedbacks, the sensory elements of the game helps them to trigger memories in the past and also enable their concentration to the game. This can validate the support of sensory stimulation therapy and reminiscent therapy research that have proven positive effects on people with dementia. . Based on the results from user testing, involving younger ones into the game can positively keep the environment less serious and youthful. They are often the ones who bring out fun and bright side of life to the family.

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As we are all ageing, sometimes the sense of fun and play may have gradually lost at some point of our lives. Memo. rable is one of the project that aims to remind people that all the fun and laughter are still inside them despite any health conditions. This multi sensory board game hopes for its best to be used as an incentive to encourage people to leave those overwhelming situation to live a memorable moment with their loved ones, once again.

APPENDICES

Design Research Method: Guided Tour

Multisensory room

Activity Room

Tactile pillow in the Multisensory Room

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Scent Kits in Activity Room

Sensory objects box in Activity room

Outdoor Space

Questionnaire pamphlets were prepared for interview

An interview focus on design aspects

An interview focus on clinical aspects

APPENDICES 8.1 DESIGN RESEARCH METHOD: GUIDED TOUR

Expert Interview Summary A

Location: Bendigo Health Expert: Occasional therapists Date: 21 March 2018 Duration: 12.00 am - 13.00 Feedback and suggestions •

• • • •

151 8.0 APPENDICES 8.2 EXPERT INTERVIEW A

• • • • • • •

Provides some clue to connect patients to their past. Family members are experts of the individuals with dementia. Therefore, involve family members in the process will help creating an effective solution for the patient. Sound and smell should be considered Personalisation is great strategy to meet individual needs. Sense of home can be involved in the activities. The limitation is the aesthetic, form, and material. Confusion of the patients towards the design should be avoided. Safety issue must be concerned. Not only for the patient, but also the carer. Something for them to have fun. Activities provided now are sensory apron, keep-hand-busy objects, cushion, stuffed animal toys, cleaning with staffs. Individual preferences are changed in each day. Something that individualised or able to change is great. Options for different senses are needed Hygiene is required Short time to set up and clean up an equipment would be preferred

Design for Dementia care

E xa m p l e

PROJECT IDEA To c r e a t e o n e - o n - o n e d e s i g n intervention that provides a meaningful activitiy for people with d e m e n t i a a n d s t a ff s , v i s i t o r s o r f a m i l y m e m b e r s t o g e t e n g a g e d t o g e t h e r. T h e design object will deliver more than one senses when in use.

Kit-based activity Ta s k s t o b e c o m p l e t e d

QUESTIONS 1. What kind of activies are suitable for older patients? ____________________________________________________________ ____________________________________________________________ 2.What are the main limitation that older patients have in terms of multisensory activities (eg. physical limitation, cognitive limitation ) ____________________________________________________________ ____________________________________________________________ 3. What do older patients normally do when they get visitors? Is there any activities provided for them to spend time together? __________________________________________________________ __________________________________________________________ 4. What sensory activities do Occupational Therapists do with older p a t i e n t s ( t h r o u g h a c t i v i t y, t h r o u g h c o n v e r s a t i o n , e t c . ) a n d w h i c h a r e t h e m o s t e ff e c t i v e ?

______________________________________________ ______________________________________________

Expert Interview Summary B

Location: Bendigo Health Expert: Occasional therapists Date: 21 March 2018 Duration: 13.00 am - 14.00

Opinions and Suggestions in General • • • • • • • • • • • •

• • •

Advanced technology can incorporated in products or services but not necessary. Tactile experience is one of the most preferable senses. The sense of empowerment is needed for the patients. Provide options ewfor them to choose are one w ay to empower patients in everyday routine. The sense of home is needed since the patients moved into the care facilities. There is no facility for patients to use as self-soothing activities such as kitchen equipment that suitable for their capabilities. There are opportunities for games. Long-lasting equipment is required. The sense of taking care of something such as plants enhances the feeling of living. The appearances and aesthetic of product and surrounding matter to cognitive impaired persons. The design should have no reflective surface and visual clutters to wavoid patients’ confusion. For both native and non-native English speakers have communication difficulties. Body language becomes a crucial part to deliver messages. Therefore, something that possibly facilitates communication between patients and occupational l therapists will be useful. Heavy soft toy are generally used. The weight of the toy can comfort them when placed onto their laps. There is a library of objects that trigger memories of dementia patients. Typically, older people with dementia do not usually ask for help. Therefore, the visual guides often used within the care environment to enhance independence of the patients.

152 8.0 APPENDICES 8.3 EXPERT INTERVIEW SUMMARY B

Expert Evaluation Summary C

Location: RMIT Univercity Expert: Design for Care experts Date: 8 April 2018 Duration: 12.00 am - 12.30

• • •

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• • • • • •

APPENDICES 8.4 EXPERT INTERVIEW SUMMARY C

• • •

Games like crossword, blowing bubbles, hiting bollon is popular for older people with dementia. Use images as a theme such as gardening, cooking. Smell can be considered to be part of the game because it is one of powerful senses not for a competition but for trigger memories. Games should be non-competitive. Games can include temperature and vibration Bring nature smell into games is a good idea Consider the conversation during the game, trying to help them connect to the past. Plastic is not an ideal material. More natural materials are preffered. Looking at what happen to the year they were born such as popular hobbies and activities and put into design will create the feeling of expert for the patients. The aesthetic should be simple to avoid confusion Consider the length of time for completing one round of games Consider the end of game converstion, Asking for their opinions such as Do you enjoy doing this kind of activities, Do you want to do it again next time?, or what do you like about this activities?

Khym Sarochinee Teerasin

Multisensory Game for Older Adult with Dementia and Their Loved Ones.

design project summary

Enable families members to engage and communicate with people who have dementia Enhance multisensory experiences through games design Provide age- and stage- appropiate product for older adults with dementia Enable carers to anticipate an individual’s reaction to specific activities throughout the games Facilitate interaction during visits

October, 2018

Date of Completation

•

Key Objectives

Older adults with dementia in the age of 60 and over, both male and female

Target Group

This object design project aims to create a mulisensory board game to provide older adults with dementia as well as families and caregivers opportunities for social interaction while successfully engage in meaningful conversations despite the progression of dementia.

Project Background

Note: The game will be personalisable in order to be relevant to individual’s background. The strategy used in the game will be adjusted for different stages of dementia.

The photo above demonstrates the intial idea of multisensory board game by developing from the traditional game, Snake & ladder. The person has to create a storytelling from each colour box of sensory objects; Red box provides tactile objects, Yellow box consists of a collection of photos, and White box offers diffent scents. She/he has to pick an object from the colour box and shares experiences, feelings or thoughts of the object. For instance, if the person steps on the white swatch on the board, he/she has to pick up one scent from the white box and guess what the scent is. Then, the conversation can continue discussing about the sensory experience.

Evaluation form is provided for caregivers to note the individual experience, reaction, preferences, emotion stage, etc. that are found throughout the game.

Board Game Kits provides different sensory such as tactile, smell, visual to enhance the multisensory experiences and reminiscene.

User Manual explain how the game should be played to be suitable for different stages of dementia.

(1) User Manual (2) Board Game kits (3) Evaluation forms

There are 3 main elements include;

This multisensory game design project will develop from traditional games for reminiscene purpose. The game will be designed to suit both physical and cognitive capabilities of individual.

Design Concept

Project Summary Poster

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APPENDICES 8.5 PROJECT SUMMARY POSTER

Notes

Touchpoint

Negotiation

Elizabeth was greeted by Elizabeth is intersted Sara, her caregiver, and to give her a company was asked if she could join Sara to play games.

Game starts

Elizabeth learn how to play the game by looking at Sara’s demonstration

Facilitation

She picks up a random smell from game kits. The smell triggers her memory of when she usually prepared breakfast for her family

Sensory objects are explored

Elizabeth continues playing games with Sara. Based on the game instruction. She was asked to create a storytelling from given objects.

Play

Visual

Tactile

Their conversation starts to share their feeling, experience and preference.

Stimulation

The game kit is personalisable to meet individual preferences and background The game requires to be play differently in different stage to meet individual’s remaining capabilities and strength

Caregiver follows the game manual

Elizabeth is bored and feel empty during the day

Recognition

APPENDICES

Emotion

Action

Interaction

8.4 8.6 PERSONA USER JOURNEY

Status Medical diagnosis Phase of Dementia

Smell

Elizabeth is asked at the end of the game about what she likes/dislikes about the game and would she do it again next time.

Valuation form is used when game ends

Elizabeth gives the feedback to Sara

Validation

“ Elizabeth is a people person, loving mother and wife. Family is the most important to her. She mainly took most of household chores such as cooking, cleaning, and gardening. She usually prepared a quick breakfast for her family before she left the house. She taught music to children at school. Her hobby was doing embroidery work while listening to her favourite music and singing along. ”

8.0

Female 65 year old Living at home with husband and with the aid of daily professional caregiver A mother of two Progressive Dementia; Alzheimer’s disease Mild to beginning moderate

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Gender Age Setting

Elizabeth Potter

Persona & User Journey

Scenerio

156 8.0 APPENDICES 8.6 SCENERIO

Interaction in Dementia Care Theory (Kitwood,1995)

157 8.0 APPENDICES 8.7 INTERACTION IN DEMENTIA CARE 8.8 STORY BOARDING BASED ON THEORY

Storyboarding based on Theory

User Testing Protocol

What is it? Memorable is a multisensory board game specially designed for elderly people with dementia as well as everyone who provides care. The board game creates opportunities for social interaction and helps older adults with dementia stay engaged in meaningful conversations despite the progression of dementia. This is a great inter-generation tool to offer an enjoyable moment within families

158

How does it work The Memorable board game involves multisensory stimulation cards, including Photo cards, Tactile cards, and Scent cards, to evoke memories, feelings, and thoughts. (Photo attached on the next page)

8.0 APPENDICES 8.9 USER TESTING PROTOCOL

Questions on sensory cards can initiate conversation and facilitate communication while the game is being played. This is a great opportunity to explore and understand the person’s experience and preference. The game documentation booklet is provided as a tool to help care providers recording information of what the person has shared from each session. Those collected information can be used in order to alter or switch to different stimuli that can spark the responses.

Impact as a therapy Memorable board gamett is based on non-pharmacological treatment research, including play therapy, sensory stimulation therapy and reminiscent therapy. In care, activities involved sensory stimulation are often linked to the memories and interests that the individual living with dementia had in the past. It also can help connection to everyday life. Game-based intervention allows the person with dementia stay engaged in activities that are meaningful to them while enable care providers to gain more knowledge about the person to enhance the quality of care. Initiating conversation through sensory stimulation cards aims to bring enjoyment to seniors with dementia, reduce anxiety and depression as well as increase social interaction.

User Testing To play the game by following the instruction.

Objectives • To understand whether users can successfully understand the game based on information provided. • To discover whether some elements of the game do or do not facilitate the user abilities, both cognitively and physically • To investigate some confusion of the users towards the game for identifying future design adjustment. • To discover how much engaging the game is to the users.

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User Testing Feedback Form Sample

160 8.0 APPENDICES 8.10 USER TESTING FEEDBACK FORM

161 8.0 APPENDICES 8.10 USER TESTING FEEDBACK FORM

Feedback Capture Grid

162 8.0 APPENDICES 8.11 FEEDBACK CAPTURE GRID

• Colorful

• User guide - text too small

• Sensory Cards

• User guide - hierarchy and arrangement

• Giving a chance to talk

• Navigation on game board

• Dice card

• Navigation on game board

• Attention span should not be long • There should be a way to capture people attention in order to invite them to play game • the same question open up to everyone not just one particular player? • What if they cannot recall those memories • What if they can no longer communicate • Does it has to play to talk about these topic?

Memo.rable User Experience Map

1. Carer learn about the game from the user manual by considering the person with dementia remainging strengths.

2. Carer asks older adult with dementia if he/she is interested to participate in the game

YES 3.(a) The older adult with dementia doesnâ&#x20AC;&#x2122;t want to join the game

3.(b) The older adult with dementia wants to join the game

4.(a) Keep the game for next time

163

4.(b) Carer sets up the game by following the user manual.

8.0 APPENDICES 8.12 MEMO.RABLE USER EXPERIENCE MAP

5. Carer demonstrate how the games is played by doing and explaining

6. The participants will participant in some sensory stimulation activities that are part of the game

6.(a) Participants will be asked to touch objects/textures to discuss on their feelings and thoughts

6.(b) Participants will be asked to smell scents to discuss on their feelings and thoughts

7. The older persons with dementiawill be asked for their opionions on this activities.

8. The older persons with dementia share their thoughts; what they like or dislike about the game.

6.(b) Participants will be asked to look at some photos todiscuss on their feelings and thoughts

9. Carer writes down the feedback in the evaluation forms for future adjustment of the game