This pilot project, which builds on the Objects of Escape initiated during Tangible Memories, explores the therapeutic potential of cutting-edge technologies, to bring nature and natural environments into healthcare settings to enhance well-being.
Using sound and image archives from the BBC Natural History Unit, we are exploring multi-sensory and immersive experiences, such as Virtual Reality, tactile ‘Mutual Instruments’ and a rocking chair that transports the sitter to the natural world through evocative soundscapes.
This collaborative project is working alongside healthcare practitioners, families, and teenage and young adult patients at the Bristol Oncology Centre, and older people living with dementia, and their families and carers at Brunelcare’s Deerhurst home.
Helen Manchester (Social Scientist)
Kirsten Cater (Computer Scientist)
Heidi Hinder (Artist, Designer, Maker)
Steve Symons (Creative technologist and sculptor)
Esther Ingram (Archives Manager, BBC Natural History Unit)
Ailish Heneberry (Commercial and Business Manager, BBC Natural History Unit)
Sam Hume (Producer, BBC Natural History Unit)
Joe Hope (Researcher, BBC Natural History Unit)
Lesley Hobbs (Manager, Deerhurst care home)
Jamie Cargill (Lead Nurse, Teenage Cancer Trust, Teenager and Young Adults cancer service South West)
Fran Hardman (Well-being co-ordinator, Teenage Cancer Trust)
Hannah Lind (Youth Support Co-ordinator, Teenage Cancer Trust)
During the second day of our rocking chair trial at Deerhurst, we were also testing out a new handheld prototype, developed by creative technologist and sculptor Steve Symons. This wooden prototype plays nature sounds and music when it is picked up, tapped, shaken, smoothed and generally explored through touch. The top surface is embedded with pebbles and pieces of wood and conceals the network of electronics and programming that is hidden inside. Underneath, on the base of the prototype is a discreet speaker.
One of the first participants to visit us in the Garden Room this morning was a resident who is new to Deerhurst and just settling in. Betty was a very jovial character who really enjoyed shaking the handheld prototype and touching the different textures of embedded stone and wood. On contact with her hands and triggered by the movement, the sound of seagulls started squawking at Betty. She laughed and joked that the birds must be hungry ‘because we were mean and had forgotten to feed them!’
When Betty tried out the rocking chair for the first time, she put her head back, closed her eyes and started singing along to one of the songs that she recognized. She reminisced about her parents as she listened to the poems and nature sounds, and described her experience in the rocking chair as ‘lovely, very moving’ and commented that she ‘could stay here all day’.
Joyce was the only repeat resident who had tried out the rocking chair on my previous visit. On the first test day, Joyce had been upset and in tears before sitting in the chair, but after listening to the audio and rocking, she became very calm and left smiling, and generally seeming much happier. Today she closed her eyes and nodded off to sleep for most of the session.
Joyce’s goddaughter Beverly was visiting today and suggested that it would be good to have the option of an automated rocking feature on future versions of the chair, as she felt that Joyce’s condition and stage of dementia would mean that Joyce would forget to rock. Beverly also tried out the chair, finding it very comfortable and when asked about her preferred audio content, she said that she would choose to listen to poetry and short stories.
During the course of this short pilot study, thirteen different people have tested the rocking chair at Deerhurst, including care staff and family, as well as residents. We hope to secure further funding next year, in order to develop these prototypes and explore, in greater depth, the benefits of nature on well-being in dementia care.
For the first time today, we are testing out the soundscape interactive rocking chair at Deerhurst, following our successful trials at Westbury Fields during the Tangible Memories project. We have six residents, relatives and staff who are all looking forward to sitting, rocking, listening and imagining, for a half hour relaxation session in the Garden Room.
As a recap, to summarise this tech-embedded piece of furniture, here is our poster from the recent Computer-Human Interaction conference in San Jose:
Designed for older people living with the advanced stages of dementia, the rocking chair plays sounds from the natural world, nature-themed poetry and music through speakers embedded in the headrest. The audio is triggered by the rocking motion of the chair, so the sitter doesn’t have to learn or remember an interaction. If the chair stops rocking, then the poems, music or nature sounds gradually fade away to quiet. The sound content plays at random, removing the onus of choice from the individual, and the associated anxiety and frustration of sometimes not being able to recall personal preferences.
Our first participant today was assisted into the rocking chair from a wheelchair, with the help of care staff and a hoist. As she listened to sounds of the dawn chorus and waves on the seashore, she asked me what was causing the rocking movement of the chair. When I told her that it was her legs, pushing herself back and forth in the chair, she was surprised but very pleased – she told me that she can’t walk. While we have largely focused on the emotional and well-being effects of the rocking chair, it seems we have underestimated the potential physical benefits as well!
There were two other highlight responses from today as well as this significant start. A lady called Thelma had felt very agitated and anxious before she joined us in the Garden Room to try out the rocking chair. By the time she left to go to lunch, she was smiling and happy, and seemed very uplifted by her experience.
Thelma said she loved the music the most (more than the poetry or nature sounds), and she rocked in time with the rhythm of the music that she was listening to. She told me that she didn’t want the music to finish and at the end, repeatedly commented on how ‘that was so lovely’ and thanked me so much for the experience. She was moved to tears, telling me ‘oh, I could cry, that was just lovely’. Bidding goodbye, Thelma shook my hands in both of hers and kissed the back of my hand as she thanked me again.
Another instance that seemed to illustrate the uplifting effects of the chair, was demonstrated by a lady called Joyce who joined us in the Garden Room in tears and was very sad and upset at the start. After sitting in the rocking chair, listening to birdsong, and to Vivaldi’s Four Seasons, Joyce began to relax and started chatting to me (about music, her father, and how she liked instruments). She recognized Wordworth’s Daffodils poem and quoted some lines from it as she was listening. She was able to sing along with several lines of ‘Let There Be Love’. She left the session seeming much happier than she was at the beginning.
Here at Deerhurst, like at the Oncology Centre, I also shared a selection of natural objects with the residents, to see which items they were drawn to pick up and handle for the different tactile qualities.
This feedback will contribute to artist Steve Symons’ decision-making with regards to which materials he will use to design and produce a handheld interactive prototype for residents to pick up and play.
From this box of objects, Joyce chose the rubber, the bamboo spoon and the silver birch birdcall whistle. With the spoon and the birch-whistle in hand, Joyce enjoyed tapping these two pieces of wood together, in time to the music she was listening to while rocking in the chair.
As well as the many positive and encouraging responses from today’s participants, it was equally useful to observe aspects of the chair and app design that will need to improve in future developments of this initial prototype. For example, Thelma found it difficult to hear many of the softer nature sounds such as the cat purring, the sound of waves on the seashore or the crickets singing. It might be that this range of sounds is too subtle for those who are hard of hearing and, in future, we could reduce the number of these types of tracks – although some people do find them relaxing and calming, as these particular sounds have a similar effect to white noise, and they seem to help people fall asleep. Volume is also an issue. Residents have very different levels of hearing and the volume needs to be adjusted for each individual, then sometimes adjusted again within each track as a piece of music will suddenly get louder or dwindle away to a volume where people think it has stopped, if they can no longer hear it.
Overall, this first day of testing the rocking chair at Deerhurst was a very valuable experience. Each of the participants seemed to gain something positive from sitting in the chair, ranging from a restful sleep to a noticeable transition from agitation to calm, from sadness to happiness.
We look forward to returning to Deerhurst again next month and hope that we will once more see residents enjoying a sense of well-being provided by the rocking chair.
We are delighted to be working with Brunelcare, renowned South West regional care provider for older people, and today we had the pleasure of our first visit to Deerhurst in Bristol to meet with the manager and have a tour of the home.
As the photos below illustrate, this is a vibrant place to live, offering lots of stimulation for those living with advanced dementia, and a busy programme of activities including gardening, swimming, singing, music – and even the occasional ‘Deerhurst’s got talent’ contest!
The manager recommended the quiet Garden Room as the best place to install the Soundscape rocking chair, and had even arranged for some astroturf to be fitted instead of carpet, to help evoke the sense of being outside:
It makes such a difference to be collaborating with such enthusiastic partners and we look forward to working towards a satisfying outcome for all.
As this pilot research phase begins, we will be building on some of the therapeutic prototypes that we developed under the AHRC-funded Tangible Memories project, and are looking forward to exploring ways of ‘bringing the outside in’ for people who have limited access to nature for protracted periods of time.
For some of the groups we will be working with, this lack of opportunity to experience the natural environment or simply go outside, will be a symptom of low immunity during cancer treatment and long-term hospital stays, with patients sometimes needing to remain in isolation for six weeks at a time.
For others, an age-related deterioration in mobility and cognition, and the disorientating effects of advanced dementia will restrict experiences of the natural world.
Nature is widely acknowledged to have restorative and therapeutic effects, so how then might it be incorporated into these healthcare settings to benefit and improve well-being, for those who can’t physically access or enjoy the reality of it?
This is just one of the many questions that our multi-disciplinary team will be researching over the next six months, as we collaborate with the Teenage and Young Adult ward at the Bristol Oncology Centre, the Teenage Cancer Trust and a Brunelcare home for older people in east Bristol.
We will be exploring the potential of virtual reality for the teenage and young adult cancer patients at the Oncology Centre, offering 360°immersive experiences of nature through specially produced film and sound content.
At the residential care home, we will mainly develop the use of the Soundscape rocking chair, which can transport the individual to a natural environment by evoking the imagination, using atmospheric sounds and audio. The rocking motion of the chair triggers sound recordings from nature, such as the dawn chorus, waves on the seashore, or walking on snow, and plays these soundtracks through stereo speakers embedded in the chair’s headrest. Other nature-themed content which the rocking chair plays at random, includes poetry like Wordworth’s Daffodils, and classical music such as The Lark Ascending by Vaughan Williams.
In both settings, we will experiment with natural materials and digital technologies to develop multi-sensory sound-emitting objects.
So where better to find nature in all its multifarious forms, other than outdoors? Surely very few representations of nature can surpass the sound, film and image archives of one of our project partners, in the BBC Natural History Unit. As a starting point for our research, I had the great pleasure of exploring some of these awe-inspiring collections, and meeting some of the archive and digital production teams for the first time, to progress some ideas about how best to begin.
I was given an exhilarating taster of some of the virtual reality films available, using both the HTC Vive headset and the more portable Samsung Gear VR. With the help of some sophisticated 360°film-making, I took a virtual trip to the Kashmiri mountains and enjoyed an underwater dive off the coast of Costa Rica. Here’s me getting very involved in one of these immersive experiences!
Afterwards I was introduced to the BBC’s digital sound library, and was struck by the sheer volume and diversity of these audio archives. In this extensive and absorbing sound store, any generic searches quickly proved pointless. For example, I needed to specify whether the sound of a storm that I was looking for, was specifically a sandstorm, snowstorm, thunderstorm, tropical storm, monsoon, hurricane or other kind of environmental maelstrom. Type ‘dawn chorus’ into the online search box, and initially, most people would expect birdsong. But dawn chorus in the rainforest includes gibbons, frogs, insects and the sound of dripping water. Dawn chorus on Talan Island however, on the Sea of Okhotsk in Russia, sounded a deafening mass colony of crested auklets.
As well as the atmospheric audio, the brief descriptions of these sound recordings conjured up equally vivid scenes:
‘Whistling wind in the harbour, with some rattling of ships rigging’ ‘Large flock of Greater Snow Geese flying overhead on the Delmarva Peninsula, Virginia’ .
These poetic snippets and their accompanying sound files gave me ideas about curating an aural story or journey for the rocking chair.
But what about unsettling and disturbing nature sounds? What about ‘European Wolves howling, ravens picking at carcass; growling, snarling, chewing and crunching bones’? Or presumably, the irritation caused by listening to a ‘High pitched whine from a swarm of brine flies’?
The BBC Archives Manager and I had an interesting conversation about our objectives for the project. In a healthcare setting, where we are seeking to improve patients’ and residents’ sense of well-being, should we only include nature content that would be considered relaxing and therapeutic? Inevitably, what is defined as relaxing and therapeutic, is also highly subjective, even cultural.
Thanks to the benefits of working in collaboration, we will be better able to address some of these questions once we start working alongside the staff and young people at the Oncology Centre, and the carers and older people at Deerhurst, in order to co-design some prototypes and experiences that they want to use and enjoy.
The first series of art workshops, where we have been working with residents from a care home to create new images and objects, each capturing a significant memory, seem to have been very much enjoyed by the participants.
Some of the paintings from the early sessions have been framed and shown at the recent Connected Communities conference in Cardiff.
One resident has a fond and vivid memory of periwinkle flowers which grew profusely in her childhood garden, and so it was this enduring image that she chose to reproduce in both watercolour (above) and scribe into the surface of casting wax (below). The wax was a wholly new material to her, but she was keen to experiment and interested to hear that it could be cast into bronze, by making a rubber mould from her original work.
When I showed D the resulting bronze cast of her artwork, she was visibly delighted, and amazed that she could have produced something that looked, in her words, ‘so expensive’. In bronze, the cherished memory now has a permanence that will last beyond the fleeting moment of remembering. As I was leaving, D made a comment that seemed to support the purpose of the entire project:
‘It’s a good idea this [project], you tell them that. It’s really got me thinking. The trouble is you get so old and you think you’ve forgotten everything, all these things – but you haven’t. The memories just need fishing out.’
Hopefully as a team, through these art workshops and the many other creative approaches, we can continue to assist the residents in ‘fishing out’ their memories, which may otherwise have drifted away.
In the book, Art as Therapy, the authors Alain de Botton and John Armstrong, go some way to echoing D’s comment:
‘We’re bad at remembering things. Our minds are troublingly liable to lose important information, of both a factual and a sensory kind. […] Art helps us to accomplish a task that is of central importance in our lives: to hold on to things we love when they are gone.’
The writers also point out that: ‘Art can be a tool, and we need to focus more clearly on what kind of tool it is – and what good it can do for us’.
The collection of fragmented objects (below) have proved extremely useful and fascinating as a set of tools for evoking memories and stories, functioning as a kind of 3D collage, where each artefact recalls something different for each individual:
In the image above, there are two RFID tags, on either side of the group of objects, and as a team, we are considering methods by which these ‘art tools’ or objects, could be augmented using near-field communication technology, in order to add a layer of story content to each item.
By exploring these digital technology options, we are, to a certain extent, seeking to ‘add value’ to some of the objects with which we are working. This has inevitably led to broader discussions about value, both the inherent and tangible value of collectable family heirlooms for example, as well as the sentimental value often attached to more personal possessions and the memories associated with them.
While prevailing concepts of the word value tend to centre around money and finance, I began to think about the significant absence of currency in the care home environment. Cash is not usually required, as the residents have nothing to spend it on in their immediate everyday surroundings, and cannot easily go out into the community without prior arrangement and support. The lack of monetary exchanges that are so integral to our daily social encounters for the greater part of our lives, are suddenly missing. Paradoxically however, the high and rising cost of care provision needs an increasing volume of financial investment to sustain it.
With money comes agency and choice, and a level of empowerment and confidence widely recognized as important for any individual. Equally, art has been identified as having a capacity for agency in a book called Winter Fires: Art and agency in old age, producedby the London Art in Health Forum and the Baring Foundation:
‘Children and young people want to be thought older than they are because with adulthood comes agency – the ability to act autonomously in the world, to make our own decisions, to pursue our desires, to write our own story. And it is the loss of agency, above all through mental incapacity, that is most feared as old age advances…..
But a capacity to create…is in all human beings, including those who do nothing to develop it after primary school. Art is a capacity for agency that….can flourish, indeed, in old age and help preserve individuality and autonomy to the very end.’
As a result of both art and money being identified means of increasing autonomy, this week I will be facilitating a type of coin-making workshop with the residents from another of the care homes, before we begin to experiment with these unique objects of value in some system of exchange, a kind of micro-currency within the care home environment.
Much like D’s wax cast into bronze, the residents can start by drawing a significant memory or symbol of something important to them, into the surface of a wax hexagonal shape. The smallest ‘coin blank’ starts at similar size to the 5 pence piece, while a much larger hexagon is available for more short-sighted participants or those with dexterity issues.
Next month, in a care home where the majority of residents are suffering from the advanced stages of dementia, we will also begin experimenting with pre-decimal money, in the form of the ‘thrupenny bit’ or threepenny coin. Tim Lloyd-Yeates, Director of Alive! Activities reminded the team that in the midst of memory-loss, the strongest recurring memories are those which we have experienced between the ages of 10 and 30 years old. For most of the care home residents, this would mean vivid recollections of using pre-decimal money.
Alongside these ideas of introducing a micro-currency into the care home environment, this Radio 4 programme explored a really interesting form of alternative currency, applied to care of the elderly in Japan:
The programme summary raises some crucial questions:
The UK, like many countries, faces the problems of an increasingly ageing society. The number of people aged 65 and over is projected to rise by 23% from 10.3 million in 2010 to 16.9 million by 2035. How can we provide and pay for their care?
Japan is at the forefront of the ageing crisis, with the highest proportion of elderly citizens in the world. By 2030, almost a third of the population will be 65 or older. At the same time the overall population is shrinking, leaving fewer young working people to shoulder the burden of paying for care for the elderly.
One creative response to this challenge at local level has been a cash-less system of time-banking. Under the fureai kippu system, individuals donate time to looking after the elderly, and earn credits which they can – in theory at least – “cash in” later for their own care, or transfer to elderly relatives in other parts of the country.
Could something similar work here, or do we have very different attitudes to community and volunteering? Who would benefit from such a cash-less scheme, and who might lose out? Could it be scaled up to meet the escalating needs of a growing elderly population?
Ultimately, whether it is time or money, art objects or memories that we will be exchanging in the care home of the future, new ways of thinking about ageing are vital now, in addition to providing a sustainable and personalised means of support for everyone.