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.
A few weeks ago, we met with the Deputy Care Manager of the specialist dementia home that we are working with, in order to discuss the possibility of testing out our therapeutic rocking chair in situ, with some of the residents.
After some very useful conversations about health and safety, in perspective with positive risk-taking to ensure quality of life, we walked around the communal areas of the home, to choose a suitable location for the rocking chair to be situated on the initial test day.
There is a lovely ‘Garden Room’ in the care home which is not often used by the residents, partly due to the slightly foreboding approach of this long corridor:
Once there however, the space is sunny and peaceful, and as its name suggests, the Garden Room overlooks a wide lawn, edged by plants, bird tables, a water fountain and flowerbeds:
The natural place for the therapeutic rocking chair was in front of the French doors, so that residents could enjoy the view of the garden, while listening to music, poetry or sounds from nature, such as the dawn chorus, the wind in the treetops or crickets singing on a summer’s evening:
On the test day, the rocking chair was trialed by eight residents and four care staff. It was very touching to watch their reactions and witness some delightful responses, not only to the chair itself as a novel item of furniture in the home, but also to the varying sound content triggered by the rocking motion and movement.
One resident, a former pilot, spent some time to begin with, exploring the surface of the chair through touch, commenting that it was like being in the cockpit of an aeroplane. Then, listening carefully to the different sounds emitting from the speakers embedded in the rocking chair’s headrests, she identified a woodpecker and an owl’s call among the chorus of birdsong, and she even cooed back to the owl in reply. As she heard the rhythmic sound of someone walking on snow, she lifted her legs up and down in time, keeping apace with them, and describing a vivid story to us about what was happening in her imagination: ‘The farmer’s on his way…’
Later in the day, we decided to adjust the sensitivity of the app so that it would trigger the sound from much more subtle movements, in order to correspond to the level of strength and capability in some of the residents. Where their own physical co-ordination had deteriorated, residents were passively rocked by a member of staff who moved the chair on their behalf. One resident was only able to activate the sound content via the app when holding my iPhone in her hand, and making small gestures to keep it moving and playing.
As a result, alongside the interactive rocking chair, we are planning to develop a handheld object-based version of the app, by embedding an iPhone into a tactile object, such as a foam ball, that could be used for armchair exercises for older people in care homes. Continuous movement of the object would similarly trigger sounds, music or poems, combining light muscle activity with a spontaneous audio experience.
On the test day, not all the residents seemed to recognise that sound was triggered by movement through the rocking motion, or necessarily to register that sound was playing at all, but this did not seem to matter. At some level, all the residents appeared to benefit from, and engage with the therapeutic rocking chair experience, even if it was simply to snooze in the sunshine, or relax and enjoy the new position overlooking the garden.
We look forward to developing our prototype over the next few months!
Following on from our pop-up exhibition of audio stories, produced from our winter visit to the MShed (see Memories and Museums) we have been developing another auditory experience using chairs, and inspiration drawn from venturing outdoors. Here I introduce the concept of a therapeutic rocking chair for older people with dementia.
Early on in the Tangible Memories project, we recognised that access to the outdoors, and specifically to the natural world, was very limited for many care home residents, often due to a decline in their physical mobility, or particularly if they were suffering from the more advanced stages of dementia. Equally, when we asked ourselves as a team, ‘what would we want in a care home of the future?’, we identified the simple routine of being able to go outside and experience the elements as something that would be of great importance to us all.
So throughout the project, we have been seeking different ways to incorporate aspects of life outside the care home environment into our technologies and prototypes, for those who are not able to venture out independently, or as often as they might like.
To begin with, we explored virtual travel using the Oculus Rift VR headset (see Virtual Reality Storytelling), with 360˚ stitched photographs of local places and museums:
We also offered VR experiences using moving imagery, sending residents to a virtual Tuscan villa, up in a hot air balloon, and even into the solar system on an animated space journey. Closer to home, we had previously recorded a kind of video postcard that reflects on the beauty of springtime in the countryside:
In this short film, as we focused on the many calming and uplifting effects of nature, such as birdsong or the sound of a river, we felt that adopting such a therapeutic approach would be particularly beneficial to residents living in the specialist dementia care home. Anxiety, agitation and memory loss are recurring symptoms of advanced dementia, so rather than placing the onus on an individual to remember past realities, we wondered whether it would prove more positive to provide an evocative soundscape of the natural world, without visual stimuli, where a person’s imagination could wander freely, and enjoy fact or fiction, in a peaceful listening experience.
With this in mind, the concept of a therapeutic rocking chair evolved, and was partly in response to Pete Bennett’s brilliant Resonant Bits harmonic user interface. This app triggers sound content on an iPhone or an iPad using a kind of rocking movement from simple subtle gestures and a slow meditative motion response. In his research, Pete asks:
How can interfaces support slow and meditative interaction in a fast paced world? How would it feel to be able to ‘tune in’ and interact directly with digital ‘bits’ of data?
Thinking about the meditative field recordings that I had already captured from nature, and wanting to combine these with Pete’s app to create a calming user experience and interaction, the traditional rocking chair seemed like an appropriate medium for a therapeutic listening experience, simply by embedding some speakers in the headrests. Rocking chairs can be a familiar item of furniture for many older people, the type of chair which provides an opportunity to dwell, ponder and relax, with its motion considered to be very comforting. (Perhaps why babies and young children are typically rocked to sleep).
In essence, this therapeutic rocking chair would play calming, comforting sound content triggered by the rocking motion. The soundscapes of nature, poetry or music would fade away and change track as the rocking motion stops and starts again, making the interaction as simple and intuitive as possible. (The chair would be silent when it was not moving). Here’s a quick demo, using just the app on an iPhone:
The rocking chair would offer this spontaneous and relaxing listening experience through hidden stereo speakers in the headrests, connected to the Harmonic User Interface app on an iPhone.
Alongside this concept development, what a bonus it was to discover a medical study published in the American Journal of Alzheimer’s Disease and other dementias which cites the psychosocial and physical benefits for dementia patients who regularly rock in a platform rocking chair:
The US study used traditional platform rocking chairs and their rocking motion alone as a form of therapy, which researchers found could improve balance, muscle tone, emotional well-being, and resulted in a reduction in the number of requests for medication to treat aches and pains in the majority of older people they tested.
If such results could be achieved with support and persistence, using a traditional piece of furniture, what more might we be able to offer residents by embedding therapeutic sounds triggered by the rocking motion? One of our key aims on the Tangible Memories project is to develop assistive technologies that enhance the social, personal and emotional well-being of older people, in addition to addressing their physical needs.
So I set to work, hacking an existing platform rocking chair in order to integrate stereo speakers into the headrests and create a quick iteration of our initial prototype so we could test the idea and get it working:
The next step required uploading an adapted version of Pete’s Harmonic User Interface app (currently called ‘SoundChair’) to my iPhone and then adding the sound content via iTunes.
The app can play any m4a, mp3 or aac file which is triggered by the rocking movement.
In addition to the sounds of nature, I’ve added other content known to be beneficial for dementia patients, which includes the rhythmic repetition of poetry, as well as classical music. Here are a few examples to give a flavour:
‘Sailing By’, Radio 4 shipping forecast theme:
The sound of waves on the seashore:
‘The Daffodils’ by William Wordsworth:
Next, the speakers were crudely connected to a battery power pack and my iPhone….
Recently we have been exploring the theme of money with a group of care home residents who are suffering from the advanced stages of dementia.
With Gill Roberts from Alive! Activities, a collection of pre-decimal coins have provided a tangible set of tokens around which the residents have been able to reminisce. Stories have emerged about how much you used to be able to buy with a ‘thrupenny bit’ or a sixpence, and what you might have chosen to spend your pocket money on as a child. (Favourites included toffee apples, ice-cream, and a ride on the neighbour’s bicycle). The subject of wages also evoked familiar memories about saving or spending, about the price of bread and the cost of a weekly shop.
As a team, we have been interested in the capacity of money to provide the individual with a certain agency, where both cash and independence are often absent in the care home environment. Equally, I have been struck by the commonality of earning, using and exchanging money as a singularly unifying experience. While the presence or absence of money in our lives is usually divisive, the physical sensation of coins in our hands, given or received in exchange for goods or services, is instantly recognisable and communal. Money is a bond after all.
The residents also seemed to enjoy the money-themed music, singing along with Bing Crosby to ‘Pennies from Heaven’, with Tommy Steele for ‘We’re in the Money’ and accompanying Doris Day on ‘Three coins in the fountain’.
During our next visit we will be hosting a tea party and providing the residents with purses of threepenny coins, each of which they will be able to exchange for a choice of tasty treats on a pre-decimalised tea-time menu. I’m intrigued to find out what a cup of tea used to cost in 1942!