Cognitive deficits have high human, social and economic costs.
People with cognitive deficits represent a significant portion of the population and their care costs are high. Thus "every year, 1,900 people suffer a traumatic brain injury (TBI) in a road accident, although three-quarters of these victims suffer a mild trauma, rehabilitation care may be indicated. TCC represents 6% of the Quebec Automobile Insurance (SAAQ) clientele but represents 28% of the costs." [SAAQ]. In 1997, the SAAQ had agreements with 28 institutions for the rehabilitation of TBI. In 2003, the only Rehabilitation Center - Estrie billed the SAAQ $ 1.8 million in rehabilitation costs for 250 people injured on the road. For their part, schizophrenics account for 1% of the population. The report on mental illness in Canada [Health Canada, 2002] assesses the economic impact of schizophrenia in 1996 in Canada as follows: total direct cost estimated at $ 2.35 billion, or 0.3% of GDP and indirect costs represent an additional $ 2 billion per year. Globally, 3% of the total burden of human disease. [Tassée and Morin, 2003] reports that the rates of intellectual disability referred to in the literature vary between 1% and 3% of the population. In the United States in 2003, [Honeycutt et al., 2003] estimated the average lifetime cost of a person with an intellectual disability at $ 1,014,000. All this without mentioning the alarming statistics related to the costs associated with the aging of the population and the increase in cases of dementia or Alzheimer's disease. For Quebecers aged 65 and over, only for Alzheimer's disease, "100,000 are reached in 2009, and this number will increase to 120,000 in 2015 and 200,000 in 2030". [MSSS, 2009] Finally, "twenty percent of Canadians will personally have a mental illness in their lifetime" [Health Canada, 2002].
On the other hand, caregivers and professional practitioners are constantly confronted with the exhaustion of the task and the scarcity of resources [Gilmour 2004], [Stockwell-Smith et al., 2010]. Also, currently, for lack of cognitive assistance and supervision systems, people suffering from cognitive deficits must too often leave their homes to live in institutions.
Cognitive assistance and tele-vigilance, a source of hope.
Around us, microprocessors multiply and invest the objects of everyday life. The networks, easily accessible, often wireless, allow to interconnect them. Thus, the rapid development of technology, combined with lower hardware costs, allows the development of applications that were still inconceivable, not long ago. Many objects of everyday life will allow innovative and unusual interactions. Our clothes will carry our profile to reconfigure our physical environment according to our preferences. The lamps will help find lost objects. Interactive portraits will reflect the health of our loved ones remotely. It becomes imperative to rethink IT and rethink our habitats. The computer becomes diffuse and ceases to be associated with the traditional computer. In our habitats, some objects will disappear to join the museums because now meaningless. Very clever, who can predict which ones!
Realizing such systems raises complex computer problems. Distributed computing, mobile computing, ambient intelligence, context sensitivity and tangible interfaces are emerging areas of research that will be at the heart of the solutions. But computing alone is not enough. Currently, it is recognized that users (patients and caregivers) must be involved from the outset in innovative design, either through participatory design or user centered design (Giroux et al., 2008). Health sciences must also be involved as early as possible in the process of developing new technologies. Thanks to their knowledge of the clientele, doctors, psychiatrists and geriatricians specify the capacities and the specific needs of each pathology in the different facets of their daily life and the management of their health. By following the beneficiaries on a daily basis, occupational therapists, psycho-educators, psychologists and social workers express concrete needs, offer methods for evaluating technologies and help communication between researchers and beneficiaries. The design helps to design adapted objects and interfaces, which will integrate into the living environment and the social network of people without stigmatizing them. In addition, new technologies will have an impact on work practices that the health administration field will be able to analyze.
Leave the laboratory to evaluate, value and transfer the solutions.
However, if these solutions remain in the laboratory or validated only in the laboratory, they are unlikely to be transferred and valued in the public. That is why it is necessary to integrate the real world into research activities. More precisely, the real world must be conceived as an integral part of a research laboratory on intelligent habitats, like the concept of Living lab [Niitamo et al. Al., 2006] [ECISM, 2009]. In addition, our experience at the University of Sherbrooke (DOMUS) Mobile Dynamics and Computer Science laboratory has shown us that it is sometimes necessary to be wary of conclusions based on simple interviews or too short tests in The time [Boisvert, 2009]. You have to go on the ground and for long periods. Since the creation of DOMUS in 2002, we have set ourselves the objective of having concrete repercussions in the lives of people with cognitive deficits. This is why we have focused on building a network of researchers and practitioners from 9 disciplines1 who have learned to work together and possess the necessary expertise to carry out this research program. We have created strong links with the world of practice. So naturally, we worked since 2003 to realize this alternative residence project, hand in hand with the Center de réadaptation - Estrie (CRE), a project that actually corresponded to a Living Lab before the letter .