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General
review
SenseCam:
A
new
tool
for
memory
rehabilitation?
L.
Dubourg
Q1 a
,
A.R.
Silva
b,
C.
Fitamen
a,
C.J.A.
Moulin
c,
C.
Souchay
c,*
aLaboratoired’e´tudeQ2 del’apprentissageetdude´veloppement,LEADCNRSUMR5022,universite´ deBourgogne,Dijon, France
bUniversite´ deCoimbra,Coimbra,Portugal
cLaboratoiredepsychologieetneurocognition,LPNC,UMRCNRS5105,universite´
Q3 Grenoble-Alpes,baˆtimentSciences
del’HommeetMathe´matiques,38400Saint-Martin-d’He`res,France
1.
Introduction
Cognitiveneuropsychologyhasfocusedinrecentyearsonthe use of wearable cameras[1], mainly tohelp patients with memorydisorders[2].Video-recordingactivitiesofdailylife hasbeendescribedasalogof‘‘lifedata’’,sometimescalled ‘‘life-logging’’(forafullreviewsee[2]).Producingaregularlog of life images raises the question as to whether such technology could be beneficial for patients with memory
disorders.Forexample,reviewingtheday’simagesmightbe helpful for recollecting autobiographical memories. Thus havingpatientsreviewtheirday’s videomightbeawayto help them remember particular events, for example the discussion they had inthe morning inthe baker’s. In this review,wewillfocusontheuseofthesetools–inparticular SenseCam,asmallwearablecamera–withthemainobjective ofprovidingatheoreticalframeworkforresearch.Themain suggestion is that the use ofthis type of toolto improve recollectionshouldfacilitateaccesstocuesandinformation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
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Articlehistory: Received30June2015 Receivedinrevisedform 9February2016 Accepted17March2016 Availableonlinexxx Keywords: SenseCam Memory Rehabilitation Alzheimer’sdisease Brainlesionsa
b
s
t
r
a
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t
Theemergenceoflife-loggingtechnologieshasledneuropsychologisttofocuson unders-tandinghowthisnewtechnologycouldhelppatientswithmemorydisorders.Despitethe growingnumberofstudiesusinglife-loggingtechnologies,atheoreticalframework sup-portingitseffectivenessislacking.Thisreviewfocusesontheuseoflife-logginginthe contextofmemoryrehabilitation,particularlytheuseofSenseCam,awearablecamera allowingpassiveimagecapture.Inouropinion,reviewingSenseCamimagescanbeeffective formemoryrehabilitationonlyifitprovidesmorethananassessmentofprioroccurrencein waysthatreinstatespreviousthoughts,feelingsandsensoryinformation,thusstimulating recollection.Consideringthefactthat,inmemoryimpairment,self-initiatedprocessesare impaired,weproposethattheenvironmentalsupporthypothesiscanexplainthevalueof SenseCamformemoryretrieval.Twenty-fiveresearchstudieswereselectedforthisreview anddespitethegeneralacceptanceofthevalueofSenseCamasamemorytechnique,onlya smallnumberofstudiesfocusedonrecollection.Wediscusstheusabilityofthistoolto improveepisodicmemoryandinparticular,recollection.
#2016ElsevierMassonSAS.Allrightsreserved.
*Correspondingauthor.
E-mailaddress:celine.souchay@me.com(C.Souchay).
Pleasecitethisarticleinpressas:DubourgL,etal.SenseCam:Anewtoolformemoryrehabilitation?.Revueneurologique(2016),http://
Available
online
at
ScienceDirect
www.sciencedirect.com
http://dx.doi.org/10.1016/j.neurol.2016.03.009
thatarepertinentforthepatient.Thisreviewoftheliterature willthusexplorehowSenseCamprovideseffectiverecallcues whichcanfacilitaterecollection.
Improvingrecollectioninpatientswithmemorydisorders isanimportantfieldofresearchinneuropsychology.Uptothe presenttime,moststudieshavefocusedonusing‘‘internal’’ strategies,forexamplecategoricalcueingorerrorlesslearning
[3,4].However,despitewidespreaduseofthistypeofaid,ithas notalwaysbeen possibletogeneralizethe resultstoother mnemonicfunctions[5].Themainreasonforthislimitationis the fact that these strategies are generally designed to stimulateaspecifictypeofmemory(forinstanceprocedural memory).Moreover,evenwhenpeoplearesuccessfulinusing these strategies to improve their performances, they are generallyunabletoapplythemintheirdailylife.Suchfailures wouldbedue,atleastinpart,tothefactthatthepatientsare unawareoftheirmemorydeficitoritsimportance[6].Indeed, certainstudiesshowthatpatientswiththegreatestdifficulty inevaluating their memorydisordersarealsothe patients who benefit least from rehabilitation because of the non-implementation of adequate strategies [7,8]. In clinical practice, internal strategies, such as the use of memory strategies, and external strategies, such as the use of technological tools, are often applied complementarily. However,theuse ofinternalstrategiescould potentiallybe hinderedbyunderlyinganosognosiasinceinternalstrategies require personal commitment, and in particular adequate awareness of the memory problems encountered. On the contrary, external aids could be easier to use and less dependentonthepatient’scognitiveresourcesormnemonic impairment.
Externalmemoryaidsaredescribedasphysicaldevices, toolsorequipmentthatallowtheusertoaccessmemorymore easily[9],forexamplepersonaldiaries,agendas,orcellphones
[10–12].However,despitetheefficacyofexternalaids,certain limitations are observed [13,14]. As for internal strategies, usinganexternalmemoryaidimpliesthattheuserisawareof theirmemorydeficit,oratleasttheyrecognizesthatmemory retrievalisdifficult.Thislevelofawarenessshouldnotonly incitethepatientstousethetool,butalsoguidethemintheir interaction with it, for example knowing what type of information shouldbe recordedorhowto accessrecorded data[15].Thisawarenessoftheexistingdeficit,orlackthereof (anosognosia),isoftenassociatedwithmemorydeficits(see
[14]forasynthesisconcerningAlzheimer’sdisease(AD)and the use of external (or internal) aids. Thus patients must consciously remembertouse the tooland consult it when tryingtorecallmemories.Inthiscontext,morepassive life-loggingtechniquesmightbeamoreeffectiverehabilitation toolbecausetheyrequireminimalpatientinput.
2.
Which
type
of
memory
to
rehabilitate?
Beyondthequestionofwhichtypeoftooltouse,thequestion ofwhichtypeofmemoryrequiresrehabilitationiscrucialin order to reach specific goals, for example maintain home residence,orpreserveself-identity.Inthiscontext, rehabilita-tionofepisodicmemory,tightlylinkedwithself-identity,isa new challenge for neuropsychology. Episodic memory isdefined as the capacity to recall information including its source,awarenessofitsorigin,andthefeelingitbelongsto oneselforisself-related[16,17].Episodicrecall,inadditionto includingspecificevent-relatedinformation(spatio-temporal framework, sensorio-perceptive aspects) [18], also provides thefeelingthattherecalledeventbelongstoone’spersonal past,afeelingdefinedasautonoeticawareness[19,20].
More recently, Kline et al. [21] proposed that episodic memoryimpliesnotonlyretrievalofcontextualinformation, but most importantly requires that the contents of the episodicmemorybeeither(i)perceivedasbelongingtoself; (ii)associatedwithatemporalsensationrelatedtoself;(iii) perceivedasbeingtheresultofanactioninitiatedbyself,or finally (iv) implicating self-reflection capacities. Episodic memoryisthusstronglyassociatedwithself.Incontrastto episodic memory, it is easier to train semantic memory, definedastheretrievalofnon-contextualized factual infor-mation[22].Thus,itiseasiertore-learnafact,forinstance Paris is the capital of France, than to re-learn one’s auto-biographicalmemory,forinstanceaweddingceremony.Tobe moreprecise,theeventsthattookplaceduringthewedding ceremonycouldbere-learnedasfacts,butperhapswithout ever becomingarealpartofthelearner’spastexperienced fromtheperspectiveoftheself.
A few studies have nevertheless attempted to improve patients’capacitytoretrieveepisodicmemory,forexampleby readingapersonaldiaryorbylookingatphotosoffamilyor friends.Inthiscontext,severalstudieshaveworkedwiththis typeofmaterialtotrytoimprovememoryinpatientswithAD: three women with moderate AD [23]; six subjects with a diagnosisofmildtomoderateAD[24];onepatientwithsevere AD[25].TheworkbyBourgeoisetal.[23]showedanincreasein the number of autobiographical events recalled after pre-sentingphotosofthepatient’severydaylifeorborrowedfrom thefamilyalbum,animprovementthatpersistedsixweeks after presentation of the photos. These results were later confirmedbyothers[26,27].SohlbergandMateer[28]studied the effectofusingapersonaldiaryand foundadeclinein repeated narratives (also see [29]). Actually, these findings describetheusefulnessofthesetoolsasamemory-aid,butno studyhasfocusedonthe specificeffecttheseaidshaveon episodicmemory.Thusitisnotclearwhetherthistypeofaid caninducethepatienttore-liveaforgotteneventsimilarto thatinducedbyepisodicrecall.Thisreviewoftheliterature willfocusontheideathatlife-loggingcouldenablerecallof episodic information byfacilitating retrieval of event-asso-ciatedinformation,inothertermsthe‘‘somethingmore’’that characterizesrecollection[30].Furthermore,thiscapacityto re-live aneventwiththemajorityofitsinitialrichness(for example,tore-livetheemotionalfeelingsoftheevent)iswhat allowsapersontomaintainacoherentself-identity.
3.
What
type
of
cue?
Rehabilitationofepisodicmemoryraisesthequestionofthe cuesthat willenableimprovement. Thecritical pointisto determinewhichtools(personaldiary,videos)wouldfacilitate retrieval of information stored in memory. As discussed above,wesuggestthatlife-loggingcouldbeanidealsupportto 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147
improveepisodicmemorizationandallowpatientstore-live their memories. The reason that life-logging could be an effective cueis based on the hypothesis of environmental support developed by Craik [31]. According to this theory, successfulretrievalofapastmemoryrequiresbothsupport from the outside environment and internal support, for example self-initiated memorization strategies. But, in memoryimpairment,forinstanceinAD,self-initiatedinternal strategic processes are affected [32,33], making external environmentalsupportallthemoreimportant.Turlvingand Arbuckle [34] distinguishedbetween ‘available’and ‘acces-sible’ information inmemory. Forthese authors,an intact mnemonictraceisavailableandthussusceptibletoretrieval, thoughitisnotnecessarilyaccessibletoretrieval.Mostofthe time, people with memory disorders are unable to find a mnemonictracespontaneously,notbecausetheinformation is not there, but because an aid is required to make it accessible.Environmentalsupportsuchaslife-loggingcould thusfacilitateretrievalofepisodicinformationinacontext whereself-initiatedmnemonicstrategiesarealtered.Inthe remainder of this review, results will be presented from studiesthathaveusedaspecifictoolfortherehabilitationof episodicmemory:SenseCam.
4.
A
new
rehabilitation
tool:
SenseCam
SenseCamisawearablecamerathattakespictures sponta-neously (without audio recording) in response to different sensors(light, temperature, sound,movement).It isa tool used to capture passive images with little or no user intervention. Users have described wearing the camera as non-intrusive[2].Furthermore,accordingtoMuhlertetal.[35], automatic image capture gives SenseCam a very high ecologicalvalue,since theimagesthatwillbeviewedlater and for which retrieval will be tested do not require any intentionalencoding.SenseCamhasawide-anglelenstoobtainamaximalfield ofview.Photoscanbetakenevery30sorinresponsetothe sensors.Thistoolisnotequippedwithameansofviewingthe imagesdirectly.Tobeviewed,imagesmustbetransferredtoa computer and processed with dedicated software [36]. SenseCamwas created byMicrosoft ResearchCambridge,and was first commercialized under the name Vicon Revue1,
beforetakingonitsmostrecentnameAutographer1(OMG
plc.).Alloftheseversions,derivedfromtheoriginal,arebased on the same principle: a camera that captures images automaticallyinorder toobtainarichset ofphotos ofthe user’s daily life [36]. In this review, we will use the term SenseCamasageneraltermincludingalltypesofwearable cameras(Fig.1).
4.1. SenseCam:thesomethingmore
Themaingoalofthisreviewistopresentresearchworkthat hasusedSenseCamasatooltoimprovememory,targeting studiesthatmeasuredepisodic recall.Wehypothesize that SenseCam(reviewingcapturedimages)willactasacueforthe retrievalofautobiographicalmemories.Ithasbeennotedin certainmemorydisorders,suchasAD,thatinformationmay
be active in memory yet inaccessible. In other words, AD patients can recognize but not recall information [37]. We suggestthatSenseCamconstitutesanaidcapableofelevating theactivationofthemnemonictraceandthusofincreasing informationaccessibility.Thishypothesisispresented sche-maticallyinFig.2(themnemonictraceisdesignatedbym).On the left,informationretrieval ispossiblewhen m isintact. Whenmisweak(m/2),ontheright,SenseCamcanhelpraise themnemonictraceaboveathresholdallowinginformation retrieval.ReviewingSenseCamimages,orafullday compres-sed into avideo,could havea beneficialeffecton episodic memory.TheimportantpointisthatreviewingtheSenseCam imagesdoesnotonlyallowaccesstoearlierevents,butalso 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215
Fig.2–AhypothesisedeffectofSenseCam.Whenmemory isaltered,themnemonictraceisactivatedbelowtherecall threshold.ReviewingSenseCamimagesincreasesthe forceofretrievalviathecuescontainedinthecontextual detailsoftheoriginalevent,thusleadingtoactivation abovetherecognitionthreshold.Contextualdetailscan thenberecalled.
Fig.1–Themnemonictraceisdesignatedbym.
increases access to the ‘something more’ characteristic of recollection.
Fromourpointofview,SenseCamismorethanasimple instrumentthatcapturesimagestobeviewedlater.Itmust alsoplayaroleconcerningthedetailcontainedintheimages themselves,whichisotherwisenoteasilyavailable.Moreover, SenseCamshouldnotonlyallowaccesstoimages,butalso affectmemorybyre-initiating thoughts,feelingsand (non-visual)sensorialinputlinkedtotheimages.Thequestionof transferisraised:couldSenseCamenableabroader impro-vement inautobiographical memory– doesthe use ofthe device transfertoimprovementsontestsofmemorymore generally?WereferheretotheideasuggestedbyLovedayand Conway[38]bywhichSenseCamwouldallowuserstoaccess ‘Proustianmoments’.
AccordingtoLovedayandConway,a‘Proustianmoment’is definedasanintensemomentofreminiscencewhenimages ofthepastoverflowintoconsciousness,producingastrong recollectiveexperience.Suchmomentsalmostalwayshavean ‘aha!’quality, oftenoffering arecollectionaccompanied by highlyspecificdetailsthatwerenotavailableand,incertain cases,notknownbefore[38].
In line with the environmental support hypothesis, Loveday and Conway [42] propose that SenseCam helps retrievecurrentlyinaccessiblememories.They suggestthat eventsin long-term memoryarenever lost as long asthe neuralnetworkswithin whichtheyarerepresentedremain stable.Thusaneventcouldremainunavailabletorecalluntil itiscorrectlycued.ThisisillustratedintheleftpartofFig.1. Theforceofthemnemonictracedesignatedbymisbasedon thelevelofactivationoftheneuronalnetworkwhenanevent isrecalled.Whentheactivationremainsbelowthethreshold, memoryoftheeventmaybepreservedbutdifficulttorecall. Asexplainedintheenvironmentalsupporthypothesis,cueing canstimulatetheneuronalnetworktothelevel ofpossible informationretrieval,leadingthustotherecallofcontextual information.
TherightpartofFig.1representsthewaySenseCamacts on a weakened mnemonic force (m/2). Our hypothesis assumes thus that SenseCam acts as a powerful cue, stimulating the event-related mnemonic trace, and thus allowingaccesstotheeventandtheassociateddetails,even includingthosenotrepresentedintheimages.This corres-pondsto a‘‘Proustianmoment’’described by Lovedayand Conway:theimage, asacue,allowsaccesstoforgottenor inaccessibleinformation.ButwouldSenseCamreallybeable togeneratesuchProustianmomentsitself,orwoulditsimply allow people to re-familiarize themselves with their past events?Thiswouldonlyhave aweakeffect ondeclarative memoryandthuswouldnotenablerehabilitationofepisodic memory.
4.2. SenseCamasamemoryrehabilitationtool
ThissectionpresentsthestudiesthathaveusedSenseCamas a memory rehabilitation tool. The databases usedfor this reviewoftheliteraturewerePubmed,ISIWebofKnowledge, and ScienceDirect. Certain studies were also identified by analyzingreferencelistsorotherreviews.Searchitemswere: SenseCam;memory;life-logging.Studieswereincludedinthis
review if their abstract corresponded to the topic under considerationandiftheymetthefollowingcriteria:SenseCam orasimilarsystemusedinthestudy;theoreticalarticleswere excluded;useofSenseCamhadtobethepurposeofthestudy (i.e.weexcludedstudiesusingSenseCamdevotedtoanalysis ofdailyactivities,learning/educationexperiences,reflection/ culture,lifedata)(foranoverviewoftheusesofSenseCamsee
[39]);thestudieshadtodescribeexperiencesproducingresults and notsimplyanalysesofamethodology, anopinionora theory. To date, two special issues have been devoted to SenseCam(Memory,volume19,issue7,2011;AmericanJournal ofPreventiveMedicine,volume11,issue3,2013).
The24 scientificarticlesselectedfor thisreview canbe divided into two categories (Table 1). The first category concernsstudiesusingSenseCamasatooltorecordpersonal data,lifeimages,withastrongcueingpotentialforepisodic recall.Theteamsworkinginthisfieldreportedcasestudiesof patientspresentingmemoryimpairments,groupstudies,and neuroimaging methods. The second category of studies examinedwhetherSenseCamhasageneraleffectonmemory performance, and thus an effect that is not limited to reactivationoftheeventsdisplayedintheimages(transfer).
4.2.1. Casestudies
Elevenselectedarticlesdescribedcasestudies.Mostwerefirst attemptsat memoryrehabilitation usingSenseCam [40,41]. Patientswithlimbicencephalitis[40],damagetothemedial temporal lobe[42], braininjury(damagetocentralnervous tissuecausedbyheadtrauma)[43],mildcognitiveimpairment (mildmemorydeficitduetoadegenerativeprocess)[42],brain tumor [44], hypoxicischemic encephalitis[45],AD[46], and Korsakoffsyndrome[47]weretestedforretrievalofpersonal memoriesafterwearingSenseCamandreviewingthe captu-redimages.
MostofthesecasestudiescomparedtheuseofSenseCam (photos repeatedly reviewed several times a week) with reading a personal diary. In these studies, patients were askedtorecalldetailedautobiographicaleventsafewweeksor afewmonthsafterusingSenseCam.Inthiscontext,thestudy by Berry et al. [41]compared theuse ofSenseCam witha personaldiaryversusacontrolconditionwherenoaidwas proposed. Thethree conditionswere performed consecuti-vely.Photosofthepatient’sdailylifeweretaken.Inthediary condition,patientswereaskedtowritedowntheeventsthat occurredintheirdailylife.Inthecontrolcondition,nospecific actionwasrequested.Attheendofeachcondition,alife-event recalltestwasperformedeverytwodaysfortwoweeks.After afirstrecall,theSenseCamimagesordiarywerereviewed. The study showed that viewing the SenseCam images increasedrecallofautobiographicalevents.Moreover,forthis study,long-termrecallwasalsoincreased,with80%recallof eventsatonemonthintheSenseCamconditionversus49%in thepersonaldiaryand2%inthecontrolcondition.Very long-term recall was alsoobserved(67% at 2 months,76% at 3 months).Incomparisonwithapersonaldiary,SenseCamthus enabled sustainedlong-term recall (resultscorroborated by
[40]ina63-year-oldwomanwithlimbicencephalitis,by[48]in a28-year-oldmanwithbraintrauma,by[49]ina55-year-old womanwithmildcognitiveimpairment,andby[44]ina 13-year old with anterograde amnesia). SenseCam was also 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332
Table1–SummaryofexperiencesusingSenseCamasamemoryrehabilitationtool.Thearticlesarelistedbytypeof
study,yearofpublication,andtypeofsample.
Authors(year) Typeof study
Sample Methods Results
Berry etal.,2007
Casestudy 63-year-oldwomanwith limbicencephalitis(MrsB)
Intra-subjectdesign 3conditions
SenseCam:reviewofphotos takenwithSenseCam Writtendiary:readingdiary Control:nomemoryaid. Recalltestedevery2daysfor2 weeks
Follow-up:recalltestedat1,2,3 monthsfortheSenseCam conditionandat1monthforthe writtendiarycondition
At1month,bettereventrecall withtheSenseCamcondition (80%)comparedwiththewritten diarycondition(49%)andcontrol (2%).
Sustainedlong-termeventrecall withSenseCam(67%recallafter2 months,76%after3months)
Berry etal.,2009
Casestudy 68-year-oldwomanwith limbicencephalitis(MrsB)
Intra-subjectdesign
Condition1:SenseCamimages takenduringamemorabletrip (firstvisittoaluxuryhotel) Condition2:SenseCamimages takenduringatrip
Condition3:SenseCamimages takenbyanotherperson Condition4:Personaldiary writtenduringatrip. Reviewofimagesorreading diaryeventevery2daysfor3 weeks(exceptcondition1). Imagerecognitiontest(Know/ Familiar/Guess)foreach conditionunderfMRI
Nodifferencebetweenconditions 1and3.Betterimagerecognition fortheSenseCamreview conditionsandwrittendiary (P<0.001).
fMRIshowedincreasedcortical activationinthefrontaland posteriorregionsforthe SenseCAmimagereview conditionversuswrittendiary
Bowen etal.,2008
Casestudy 36-year-oldwomanwith damagetothemedial temporallobeandsevere anterogradeamnesia(Mrs CB)
Intra-subjectdesign Administrationofanevent (boardgame)3timesaweekfor 4weeks
3conditions:visualrecordingof theeventwithSenseCam,audio recording,norecording Immediateanddifferedrecall tests(5,15,30,50min)ateach eventadministration. Recalltest:questionsonthe eventswithdifferentlevelsof difficulty
Delaywasmaineffectonrecall forthe3conditions(P<0.01) NoSenseCameffectonrecall (P=NS)
RecallcuebetterforSenseCam conditionvscontrol(P=0.01, SenseCam=3,control=2.1)
Doherty etal.,2012
Casestudy Healthy34-year-oldman(Mr CG)
SenseCamimagestakenfor2.5 years.50importantevents selectedbysubjectandby dedicatedsoftware.Then randomselectionof50events. Subjectratedpersonal importanceofeachevent. Investigationofthesoftware capacitytoidentifyimportant personalevents
Thesubjectattributedhigher scorestoself-selectedevents comparedwithsoftware-selected events.Subjectattributedhigher scorestosoftware-selectedevents thantorandom-selectedevents
Browne etal.,2011
Casestudy 56-year-oldwomanwith mildcognitiveimpairment (MrsW)
Intra-subjectdesign
2conditions:SenseCam,written diary
6remarkableeventsperformed, recalltestevery2daysfor2 weeksandreviewofimagesor readingdiaryaftereachrecall test
Differedrecallat1,2and3 monthswithoutcueing(image reviewordiaryreading) Quality-of-lifequestionnaire
BetterrecallfortheSenseCam conditioncomparedwithdiaryfor short-termrecall(64%vs51%)and longtermrecall.Sensecam short-termrecall(68%vs30%) Decreasedstressandincreased confidencewithSenseCam
333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 Table1 (Continued)
Authors(year) Typeof study
Sample Methods Results
Lovedayand Conway,2011
Casestudy 47-year-oldwomanwith damagedmedialtemporal lobe(MrsCR)
Intra-subjectdesign
2conditions:SenseCam,diary Onediscreteeventrecorded eachweekfor4weeks Freeandcuedrecalleachweek. Comparisonofnumberof episodicdetailsrecalled
BetterrecallintheSenseCam conditionvsdiary(P<0.05).More episodicdetailsrecalledwith SenseCam(329)thanwithdiary (250)
Pauly-Tackacs etal.,2011
Casestudy 13-yearoldwithanterograde amnesiaduetointracranial metastases(PatientCJ)
Photostakenduringawalkwith keylocalizations(artgallery, cafe´,church.).Commentswere madeabouteachvisitedsitein ordertogeneratecontextual informationtobetestedlater. SenseCamwasoperatingfortwo sitesandnotoperatingfortwo others
Imagerecognitionat2,10and15 weeks
Increasedimagerecognitionfor SenseCamimagereview conditionofbutonlyfor informationcontainedinthe images.SenseCamwouldthusaid informulatingpersonalsemantic memories
Garrood,2012 Casestudy 10-year-oldgirlwith encephalopathicischemic hypoxia(PatientAB)
SenseCamwornduringa treasurehuntcontainingcuesat certainsitesandactionsto perform.Recalltest24hlater thenreviewofSenseCam imagesat+24hand+1month
Preliminarydata
Improvedrecallonlyforevents containedintheimages. SenseCamhelpsformulate personalsemanticmemories Piazek
etal.,2012
Casestudy 85-year-oldmanwithmild Alzheimer’sdisease(MrJ)
SenseCamusedfor7weeks. Imagesviewedtwiceaweek withrecordingofcommentsand thoughtsabouttheimages
Betterdetailrecallconcerning eventsanddetailsrecallednot seeninSenseCamimages Svanderand
Evans,2013
Casestudy 51-year-oldwomanwith moderateKorsakoff syndrome(MrsA)
Evaluationofsubjective memory,self-esteem,anxiety anddepressionafterusing SenseCam
Improvementinsubjective memoryandself-esteem (4.36-pointincrease).Nochangein mood
Sellen etal.,2007
Experimental group
19healthyyoungadults(10 male,9female,age18–22 years)
Intra-subjectdesign 3conditions
PassiveSenseCamimage capture;activeSenseCamimage capture;control
Short-term(3dayslater)and long-term(10dayslater) memorytests:remember/know/ guessparadigmandrecognition test
Greaternumberofeventsrecalled withSenseCamcomparedwith controlcondition(beforeP<0.02, afterP<0.03)
GreaternumberofK(known) eventswithSenseCam.Better eventrecallforpassiveversus activecapture
Dohertyand Gurrin,2009
Experimental group
3healthymales ReviewofSenseCamimages recordedovera1-monthperiod andmarkingboundaries betweeneachevent Repeated1and2yearslater
Boundariesdeterminedbetterby personswholivedtheevent.Loss ofboundariesafter1and2years
Kalnikaite etal.,2010[71]
Experimental group
18healthyadults(4female, 14male,age25–56years)
Intra-subjectdesign
2conditions:SenseCamimages andGPSfor2weeksvsnoaid ReviewofSenseCamImages5 weeksafterevent(imagesalone, images+GPS,GPSalone) Remember/know/guess paradigm
Betterdetailrecallwith SenseCam+GPS(P<0.01) SenseCamaloneandcontrol conditionidentical(P>0.05) SuperiorrecallforSenseCam alonecomparedwithGPSaloneor GPS+SenseCam(P<0.01) Milton etal.,2011a, 2011b Experimental group
15healthyyoungadults(8 male,7female,age18–25 years)
SenseCamusedfor2days. Remember/Knowtestunder fMRI
Studyrepeated5monthslater with10participants
Retrievaldidnotcauseany activationinthemedialtemporal lobeaftera5-monthdelay.But superioractivationofthe parahippocampalposteriorgyrus forfamiliarityversusremember wasobserved
Recruitmentofextra-medial temporalloberegionswhen memorieswerefar
333 334
Table1 (Continued)
Authors(year) Typeof study
Sample Methods Results
Sasetal.,2013 Experimental group
14healthyyoungadults(7 male,7female,age18–23 years)
SenseCamandSensewearused for6hr.
Attheendoftheday,reviewof4 photoswithstrongemotional intensityand4photoswith weakemotionalintensity
Emotionalintensityincreased detailrecallfortheevents (P<0.01)
Theevent,thelocalization,and associatedemotionswere recalledbetterthantemporality orthoughts,irrespectiveof emotionalintensity Seamon etal.,2013 Experimental group
144healthyyoungadults aged17–23years
Inter-subjectdesign
3conditions:Sensecam,diary, noaidforawalkwhereatypical actionswereperformed Afterthewalkthegroupwas dividedin2forphotoreview, individuallyoringroup Reviewperformed1weekbefore freeeventrecall
Socialreminiscencebetterthan self-reminiscence(0.78vs0.64) Recallofatypicalactionsnot differentbetweenSenseCam (0.74),diary(0.69)andcontrol (0.68)
StJacques etal.,2013
Experimental group
Study1:42healthyyoung adults(15male,27female, meanage21.1years) Study2:43healthyyoung adults(18male,25female, meanage21.41years)
Study1:guidedvisittoa museumwithSenseCam 18hdelaybeforeviewingany newimages
Chronologicalmanipulationof theimages.
Study2:sameprocedure, manipulationconcernedorigin ofimages(selfversusother person)
Betterrecognitionofimages belongingtoownexperience versussomeoneelse’simages (P<0.01)
Higherrateoffalserecognition withnewimages(P<0.01) Improvedmemory,butalsofalse recognitions(P<0.01) StJacques etal.,2011 Two experimental groups 23healthysubjects(12 female,11male,age18–35 years)
Intra-subjectdesign
SenseCamanddiaryfor6days fIRM1dayafterreviewing SenseCamimagesandverbal cuing+subjectiveevaluation
Superiorsubjectiveevaluationof vivacity,reviviscence,
importance,emotionand uniquenessforSenseCam condition(P<0.01)
fMRIpatternmoremarkedfor menthanwomen,better activationoftheleft
hippocampus,theretrosplenial cortex,theleftinferiorfrontal gyrusaswellastherightoccipital cortexfortheSenseCam conditioncomparedwithdiary Silva
etal.,2012
Two experimental groups
15adultsand14elderly adults
Intra-subjectdesign
SenseCamusedfor3daysthen diaryfor3days
Neuropsychologicaltestsafter eachcondition
(conditionscounterbalanced, paralleltestforms)
Betterperformanceonall neuropsychologicaltestsafter SenseCamvsdiary(example: autobiographicalmemory, P<0.01;sizeeffect0.82) Strongimpactonmemorytasks andexecutivefunctions Muhlert etal.,2010 Two experimental groups: controlvs clinical
11patientswithtransient epilepticamnesiaand11 matchedhealthycontrols
SenseCamusedduringa culturalvisit.
Imagesreviewedthesameday then1and3weekslater Comparisonofforgottenevents, forgotteneventsonalistof words,andaprocedural memorytask
Acceleratedforgetfulnessinthe amnesiagroupforeventmemory, maximumnumberofforgotten eventsonfirstdaycomparedwith controls(P<0.05).Declarative memorywasspecifically forgotten;theproceduralmemory appearedtobeintact
Woodberry etal.,2014
Clinicalgroup 6adultswithmildto moderateAlzheimer’s disease(age64-84yrs)
2conditions:SenseCam,written diary
Patients’memoryofanevent, followedbyreviewofSenseCam images,wastestedevery2days for2weeks
Recall3monthslater
Betterrecallofdetailsforthe SenseCamconditionversusdiary (P<0.01)
Long-termresults(3months)4/5 patientsrecalledmoredetailsof theevents
describedinthesestudiesasaffectingrecallspecificity(more detailswereprovidedforeventsseeninimages)[2,43].The authors did not state whether the details provided were present in the images themselves, but we can tentatively suggest that the extra details recalled were an effect of SenseCam.ThestudybyLovedayandConway[38]conducted ina47-year-oldwomanwithadamagedmedialtemporallobe alsoshowedincreasedspecificityforeventsnotpresentinthe images,resultsthatsupportourhypotheses.
Elsewhereamongthecasestudies,twostudiesindicated an improvement in semantic autobiographical memory
[44,45]. Pauly-Takacset al. [44] studied a 13-year old with anterograde amnesia due to intracranial metastases and Garood [45] studied a 10-year old with encephalopathic hypoxicischemia.Theseauthorssuggestthatthebeneficial effect of SenseCam observed in their patients is due to a changeinpersonalsemanticinformation.Forinstance,one patientrecalledwhilstreviewinghisimages,thattheimage showedthelongestcorridorinEurope,adding‘‘Iwentthere’’. This appears to suggest a re-learning process, or what Kalnikaite and Whittaker
Q4 [40] call an ‘inference’ from the images,re-statedasafact.Thesepeoplecould‘recognize’or extrapolatefromeventsdepictedintheimagesandrelearn this information as personal knowledge that would be recordedinthesemanticmemorysystemandnotinepisodic memory.
4.2.2. Groupstudies
OtherstudieshaveexploredtheusefulnessofSenseCamin theprocessofnormalagingandinspecificclinical popula-tions. These studies reinforce the idea that SenseCam improves both episodic memory and personal semantic knowledge.Manyofthesestudieshavemeasuredthenumber ofitemsretrievedafterviewingSenseCamimages (quantita-tive analysis), but alsoself-assessed memory performance (qualitativeanalysis).Thislatterapproachisessentialforour hypothesis.Indeed,ourhypothesissuggeststhatSenseCam enablesanimprovementintheepisodicaspectofmemory. SenseCam should not onlyhave a beneficial effect on the
amountofinformationretrieved,butshouldalsoimprovethe qualityoftheinformationrecalled,withmoredetail,anda richerexperienceforpastevents.Animprovementinepisodic memory with SenseCam has been demonstrated both in healthypopulations–a groupof3men[50], agroupof18 adults[28],agroupof14youngadults[51]–andinpopulations presentingwithmemorydisorders–3adultswithAD[52],5 adultswithADormildcognitiveimpairment[53],6adultswith AD[1].
Studiesincohortsofhealthyparticipantsshowthattheuse ofSenseCamleadstoimprovedrecollection.Sellenetal.[54]
(19 healthy young adults) probably provided the clearest example showing an improvement in recollection. These authorstested19studentswhohadwornaSenseCamfor13 consecutive days using imagerecognition tests(SenseCam captures)whilewearingtheSenseCamondays3and10.Three conditionswereused:inthefirst,SenseCamcapturedimages passively; in the second images were captured actively (capture triggered by the participant); in the third photos taken by other people were used as a control condition. Memorywastestedthreeways:aself/othercondition(isthis photooneofyours?);aclassificationtestwhereimageswereto beplacedinchronologicalorder;andarecalltestwherethe participantsgeneratedtheeventsofthedayindetail.Thistest examined free recall before and after viewing 10 images (SenseCamorcontrol).Forthisrecalltest,theparticipantshad toclasstheirmemoriesasbeingeitherrecollectedormerely recognized ‘known’ [30]. The results showed that simply wearingtheSenseCamconsiderablyimprovedretrievalofthe day’sevents.Theeventsclassedasknownwererecalledless and SenseCam had no effect on these memories. The classificationtaskdemonstratedthattheparticipants classi-fiedmoreeasilytheirowneventsofthedaythantheeventsof another person.Fortherecognitiontask,anumberoffalse positiveswereobserved,butthemajorityoftheparticipants successfully(80%)discriminatedtheirownphotos. Summa-rizing, the resultsof Sellenet al.underscore the ideathat SenseCam improveseventrecall,but alsopermitsaccesto detailswhicharerecollected.
333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 Table1 (Continued)
Authors(year) Typeof study
Sample Methods Results
LeeandDey, 2008
Clinicalgroup 3adultswithmild Alzheimer’sdisease
Intra-subjectdesign Significantpersonalevents recordedusingSenseCamfor2 weeks,audioandGPSrecordings 4conditions:control(noaid), patientswearingSenseCam, caregiverwearingSenseCam, caregiverwearingSenseCam andselectingimages
Recallandnumberofdetailswas greater(ca.40%recall)when patientsworeSenseCam comparedwithcaregiverwearing SenseCam(P<0.05).Inthislatter condition,performancesdeclined (ca.10%recall,P<0.05)
Crete-Nishihata etal.,2012
Clinicalgroup 5adultswithAlzheimer’s diseaseormildcognitive impairment
SenseCamusedfor3short journeyswithanassistant Aftereachjourney,evaluation for2weekswith5
autobiographicalinterviews 3monthsaftereachevent, autobiographicalinterviews wereagainconducted
Betterepisodiceventrecallforthe SenseCamcondition(for4/5 participants)(P<0.05)
fMRI:functionalmagneticresonanceimaging.
Thesegroupstudieshavealsocontributedtoaclarification oftheusefulnessofSenseCamincomparisonwithothertypes ofrecordinginstruments,acriticalpointforits statusasa rehabilitationdevice.Sellenetal.[54]forexampleconcluded thatinthecontrolpopulation,passivecaptureofSenseCam images (according to the on-board sensors) is better than activecaptureobtainedwithordinarycameras.
Certain studies have however questioned the idea that SenseCamisassociatedwithanimprovementinmemory[55]. StJacquesandSchacter[55]studied53healthyyoungadults andsuggestedthat SenseCamhelpsimprovethequalityof judgment concerning the images, but also contributes to increasedfalserecognitionwithconfusion betweenimages takenbytheparticipantandimagestakenbyothers.Intheir study[55],theauthorscomparedrecognitionbetweenimages of actions actually performed and new images (similar environment, but not where the participant had been). According toSchacteret al.[56], this taskwould leadto a confusionofthesourcememorybecauseofthesimilarityof thephotos.Inasimilarstudy,Seamonetal.[57]asked144 healthyyoungadultstorecallatypicalactionstheyhadmade aweekearlier (forexample press theelevator button with one’selbow).TheresultsshowedthatSenseCamreviewdid not contribute to better recall of atypical actions actually performedandthusdidnotenhancememory.
Certain group studies have also focused on improved mnemonic performancewithSenseCam duringthe normal agingprocess[58].Silvaetal.[58]studied15youngadultsand 14olderadultsfocusingontheevaluationofaglobaleffect (recall of information contained in the images was not measured) using standardized neuropsychological tests. In this study, the participants wore a SenseCam for three consecutivedaysthenwroteapersonaldiaryforthreemore days. Neuropsychological tests were performed after each phase. The resultsof this study show an improvement in memoryforall ofthemnemonic measuresstudied(testof autobiographicalmemory[59],freerecall/cuedrecallFR/CR16
[60],symbolsearchandcoding[61],monthordering[62]),that was only present after using SenseCam for three days (in comparisonwithreadingapersonaldiary).Theseresultsthus supporttheideathatSenseCamstimulatesmemoryingeneral anddoesnotsimplycuetherecallofinformationpresentin theimages.
Finally,certainstudieshaveexploredtheuseofSenseCam ingroupstudieswithclinicalpopulations.Muhlertetal.[35]
studiedtwogroupsofsubjects(11epilepticpatientsversus11 healthy subjects) to compare how verbal and non-verbal memory is forgotten over time in patients with transient epilepticamnesia.Inthisstudy,visualmemorywasassessed usingSenseCamphotos.ThepatientsworeaSenseCamwhile takingwalks.MemoryoftheeventscapturedbySenseCam was tested at 3h, 1day,1 weekand 3 weeksafter image capture.Fivephotoswerepresentedtotheparticipantswho weretorecalltheeventdepictedinthephotoandgiveasmany detailsaspossible.Theresultsshowedthatasimilarnumber of events and details were recalled 1 day after the photo capturebyboththepatientsandthecontrolgroup,butthat during the following three months epileptic patients lost memoryoftheeventsmorerapidlythan thecontrols.This studyisalittledifferentbecauseitusesSenseCamtomeasure
memory in a naturalistic manner, rather than seeking to improvememoryfunction.Inamorerecentstudy,Woodberry et al. [1] studied the SenseCam effect on autobiographical memoryperformanceinasampleofsixpatientswithmildto moderate AD.Thepatients’memoryofeventscapturedon SenseCamwas testedtwiceaweekfortwoweeks. Compa-risonwithawrittendiaryshowedasignificantimprovement in the number of details provided when using SenseCam. These results confirm that the use of SenseCam in these patients isassociated withan improvementin autobiogra-phicalmemory(resultscorroboratedbyLeeandDey[52]and byCrete-Nishihataetal.[53]).
Insum,themajorityofthestudiespresentedhavefounda beneficial effect of SenseCam on retrieval of information storedinmemory.Indeed, allofthe studiesemphasizethe increaseinboththequantity–numberofeventsrecalled–but alsothequalityofthememories, withagreaternumber of detailsprovidedabouttherecalledevents.Nevertheless,the studiesreportedhereremainquiteheterogeneousintermsof themethodologiesusedandtheclinicalpopulationsstudied. In other words, the question of the beneficial effect of SenseCamremainstobefullyelucidated.
4.2.3. Neuroimagingstudies
Partofthestudiescitedabovereportneuroimagingdatathat also provides information concerning the hypothesis that SenseCamleadstoanimprovementinepisodicrecall.These studiesfocusontheactivationofbrainregionsimplicatedin memory,particularlythemediotemporalregionsoften asso-ciatedwithrecollection[30].InastudybyMiltonetal.[63], participantsworeaSenseCamfortwoconsecutivedaysthen performedimagerecognitiontestswithfunctionalmagnetic resonance imaging (fMRI) 36 hr and 5 monthsafter using SenseCam.Theresultsin15younghealthyadultsrevealedan activation of the right anterior and posteriorhippocampal regionswhentheparticipantsreviewedSenseCamImages36 hraftertheircapture[63].Afteralongerdelay(5months),the images triggered an activation of the neocortical regions (medialprefrontalcortex),regionsassociatedwithstrategies involvedinmemoryretrieval.InastudybyStJacquesetal.
[64], the participants wore aSenseCam forsix consecutive days and one week later had an autobiographical event retrievaltestunderfMRI.SenseCamimageswereusedascues. Thisstudycomparedbetweenmenandwomentheimpactof viewingSenseCam imagesonbrainactivationduring auto-biographicalretrieval.Activationofthemedialtemporallobe was alsorevealed.Theresultsofthesetwostudiessuggest thattheprefrontalcortexandthemedialtemporallobeare activatedbySenseCamgivingforceandlongevitytomemories
[63]. The purpose of SenseCam being to capture self-referential information, the study by St Jacques et al. [63]
supportsthenotionthattheself-projectiongivenby Sense-Camwouldactivatethemedialprefrontalcortex.Themedial prefrontalcortexstimulatesthemedialtemporallobe asso-ciatedwiththememoryprocess.Thus,theincreased activa-tion of the medial temporal lobe would allow retrieval of information indispensableforsuccessful recollection (infor-mation depicted in the images, contextual information, autonoeticawareness)asproposedbyLovedayandConway
[38]. 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528
5.
Discussion
Wewillbeginthisdiscussionbypresentingthecharacteristic featuresthatmake SenseCamabeneficial toolformemory rehabilitation. The first characteristic was described by Conway[65]asthe‘mimetism’ofautobiographicalmemory. SenseCamcapturesimagesfromanegocentricpointofview and does not require explicit intervention by the user. AccordingtoConway[65],capturingimagesfroman egocen-tricpointofviewisessentialfortheefficacyofSenseCam. Moreover, earlier studies have demonstrated that photos takenfromone’sownviewpointenableamorevivid,more specificandmoreemotionalmemoryretrieval[66].Thisthus leadsto‘mentaltimetravelling’.Theseresultshavealsobeen corroborated by neuroimaging data [65]. Neuroimaging demonstratesanactivationoftheneuronnetworks implica-tedinre-experienceofthepastandinautonoeticawareness, viareviewingSenseCamphotos.TheSenseCamphotosinduce animportantfeelingofidentity,sustainingstrongmnemonic traces[38].Thisrepresentsthe‘somethingmore’hypothesis where recalled information goes beyond the information presentedinthephotosthemselves[38,44].
Another characteristic feature making SenseCam a sui-tablerehabilitationdevicecomesfromthefactthatthetool requiresverylittleuserinput,beingarelativelypassivedevice. Certainpatientswithmemorydisordersarealsoanosognosic and thus have only minimal perception of their own difficulties. The advantage ofSenseCam is to provide this typeofpatientwitharehabilitationtoolthatrequireslittleor noawarenessofthedisorder.Asideofwearingthedeviceand reviewingtheimages,thereisnoneedforactiveinvolvement withthedeviceduringitsoperation.
The final characteristic is the capacity ofSenseCam to compensate for deficient self-initiation processes, again a problem oftenpresent inpatients withmemory disorders. Most of the time these patients, because of altered self-initiation processes, fail to find sought-for information spontaneously(duetoanabsenceofcontext).Here,SenseCam canplayacriticalrolebyprovidingthenecessarycontextto triggersuccessfulinformationretrieval.
Oneofthemajorproblemsinthestudiesreviewedhereis thelackofstatisticalpoweroftheeffectsreported.Exceptinga small number ofstudies[55,57,58,35,64], the majorityhave been reports of individual cases or small groups of users (n<20).Consequently,theresultsobservedtodateneedtobe confirmed. Furthermore, the beneficial effect ofSenseCam couldbediminished byapossiblecognitive overloadeffect caused by reviewing the images. SenseCam sometimes captures a large volume of information that might induce mnemonicoverload[38],orevencognitivefatigue.Inresponse tothisproblem,recentstudies[e.g.2]havebegunexploring the possibility of segmenting the events, dividing them accordingtodifferentbenchmarkssuchastheenvironment, thetimepoint,thethemeorthepersonsinvolved.Thusthe purposeofthestudybyDohertyetal.[2]wastodevelopa segmentationprogrammimickingthewaymemoryfunctions. ThustheSenseCamimagesthatwereclassedaccordingtothe differentbenchmarkswouldprovidebettercuesforepisodic recallandavoidpossibleoverloading.
Thestudiespresentedinthisreviewoftheliteraturethus suggest that SenseCam has a beneficial effect on episodic memoryperformance aswellason certainother cognitive domains, including executive function. Silva et al. [58]
assessed executivefunctions bytesting verbal fluency and foundimprovedtestperformanceafterusingSenseCam.The focus on memory function is a limitation of the existent research.Forexample,therehasbeennoassessmentofthe impactofSenseCamonsubjectivecomplaintsor quality-of-life.Andthegoalofrehabilitationisnotlimitedtoasimple improvement in memory performance, but is aimed at improving the patient’s quality-of-life. It would thus be necessarytoassessthesecriteriainfuturestudies.
Oneofthe questionsthat alsoremain tobeexploredis whether theuse ofexternal aidssuchasSenseCam would improve patients’ awareness of their memory problems (metamemory). Theliteratureshows thatpeoplewhohave mnemonicdisorderspresent,forthemajority,metamemory deficits[67].Certainstudieshaveshowedthatawarenessof memoryproblemshasapositiveimpactonrehabilitation,and thusonmemoryperformance[68,69].TheuseofSenseCam, viaimprovedawarenessofmnemonicdisorders,couldthus indirectlyimprovememoryandpotentiallyhaveanimpacton themnemonicand/orcognitivecomplaint.
Oneofthehypothesesweputforwardatthebeginningof thisreviewwasthefollowing:SenseCamcouldconstitutean adequateenvironmentalsupport,actinglikeacueforretrieval ofautobiographicalmemories.Overall,theresultspresented in this review would appear to confirmthis hypothesis of environmentalsupport.Furthermore,SenceCamconstitutesa particularly appropriate tool for memory rehabilitation in comparison with other available tools. Neuropage [70] for example,isapagingsystemthatwasdevelopedforpatients withmemorydisorders.Thistoolworksbyreminders.Alistof thingstorecallcanbeinsertedintotheNeuropagesoftware thatthenautomaticallysendsarecallmessagetothepaging system atthe appropriatemoment. Alone,this toolcannot improveprospectivememory.Coupledwithothertoolssuch as a personaldiary, Neuropage mightbe able to influence othertypesofmemoryfunctions,forinstance autobiographi-cal memory. However, this would mean that the patients would have to use two tools instead of one, a further constraint.Wilsonetal.[70]evaluatedtheeffectofNeuropage in143patientswithbrainlesions(headtraumaorstroke).The patients presented at least one ofthe following disorders: memorydisorder,planningdisorder,attention,or organiza-tionalproblems.TheimpactofNeuropagewastestedtwoto seven weeks after beginning to use the tool. The results showed improved execution of daily activities (personal hygiene,useofmedications...)formorethan80%ofpatients. Neuropagethusappearstoreduceobservedmemorydeficits andorganizationalproblems.
Svobodaetal.[10]testedtheuseofacellphoneaswellasa ‘personaldigitalassistant’inordertostimulatememory.This study,conductedin10amnesicpatients,demonstratedthat theuseofthesedevicesdiminishedconsiderablydeficitsin prospectivememory(forgottenappointments,taking medica-tion).AnotherstudybyQuittreetal.[12]usedacellphoneto createanautomaticagenda.Inthiscasestudyconductedina patientwithmildcognitiveimpairment,theresults demons-529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646
tratedabeneficialeffectofusingthememoryaid.Despitethe demonstrationofthebeneficialeffectofthesetechnologies (Neuropage,personaldigitalassistant,cellphone)onmemory, thesetools,unlikeSenseCam,donotenablerehabilitationof episodic memory, but rather mainly influence prospective memory.
Finally, SenseCam-like rehabilitation tools have been implementedoncellphones[11].Patientshavetowearthe cell phone on a neck strap so that it can capture images automaticallythroughouttheday.Theeffectofreviewingthe acquired images on autobiographical memory was tested. Thesetwotools(cellphoneandSenseCam)weresimilarinall waysintermsofuse,butthecellphonehadtheadvantageof data transfer; it captured images throughout the day and transferredthemtoasafeserverautomatically.Videoswere rapidlycreatedfromthephotosandsenttopatientsbyemail orDVD.Theadvantageofbeingabletotransferimagesand rapidlycreatevideosisundeniable,especiallyforlongitudinal implementations where the videos should be reviewed regularly.ForSenseCam,theinvestigatorneedstovisitthe patientathomeregularlyinordertotransfertheimagesand createvideos–orthe patients’caregivercould betrained to transferimagesandcreatevideos.Thisaddsasupplementary constraint, in addition to using the tool. The cell phone eliminatesthisproblembyitsdatatransferfunction.
6.
Conclusion
In conclusion, the studies presented in this review ofthe literaturehavedemonstratedthepotentialofSenseCamasa techniqueformemoryrehabilitation.Thegoalofthisreview was toprovide a complete updateon publishedstudies in ordertosetthebasisforsolidtheoreticalanalysisconcerning the memory improvement obtained via SenseCam. At the presenttime,theevidencesupportingtheefficacyof Sense-Cam is weak, though positive. It is also noteworthy that becauseoftherapiddevelopmentofthesenoveldevicesthe researchconductedtodatehasbeenhighlyheterogeneous, leavingmuchroomforfurtherstudyinthisfield of neuro-psychology.Inthe longrun, studiesshouldfocuson much morequalitativeaspectsofthequestion,testingtheeffectof thistoolonpatients’quality-of-lifeandmetamemory.They shouldalsoprovidesolidevidenceconcerningthe‘something more’ hypothesis assumed to result from the use of SenseCam.
Disclosure
of
interest
Theauthorsdeclarethattheyhavenocompetinginterest.
Acknowledgements
Thisreview ofthe literatureisbasedon apreviousreview published by one of the authors (Ana Ria Silva, Neuropsy-chological Rehabilitation)and isan updatethat includes new materialonthe comparisonofdifferentmemoryaids. This workwas supported by theBourgogne Regionas partof a
projectgrantedtoCe´lineSouchayandChrisMoulin onthe theme ‘‘Consciousness and Memory in AD’’ and was also supportedbytheMe´dericFoundationthatprovidedgrantsfor Ce´line Souchay and Chris Moulin on the theme ‘‘New TechnologiesinAlzheimer’sDisease’’.
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