Brain Health in the Pervasive Neurotechnology Era

Brain Health
in the
Pervasive
Neurotechnology
Era

Welcome! #sharpbrains2015
Sponsors

Alvaro Fernandez,
CEO of SharpBrains
Welcome Remarks: Brain Health
in the Pervasive Neurotechnology Era

The Digital
Revolution Meets
The Human Brain
= Pervasive
Neurotechnology

How can consumers and professionals
harness this opportunity to better monitor
and enhance brain health, and to improve
work and life?
• Watercooler chats
• LinkedIn
• Session @ Expo Day
• #sharpbrains2015
3) THE CHALLENGE

How to harness neuroplasticity and digital tools to
enhance work and life
Chaired by: J. Peter Kissinger,
President and CEO of the
AAA Foundation for Traffic Safety
Dr. Peter Delahunt,
Research Scientist
at Posit Science
Dr. Ruth Wolever,
Chief Science Officer
at eMindful
Danny Dankner,
CEO of Applied Cognitive
Engineering (ACE)
Brig. General Pete Palmer,
Director of the
EDGE Innovation Network

J. Peter Kissinger
President and CEO

AAA Foundation
• Established in 1947
• 501(c)(3) Not-For-Profit
• Research affiliate of AAA/CAA
• North American Focus
• Funded Through Generosity of:
Mission:
• Identify traffic safety problems
• Foster research that seeks solutions
• Disseminate information & educational resources
“Saving lives through research and education”

2015 Major Research
• Over 20 active projects including:
 Safety Culture
 Teen Driver Safety
 Distracted Driving
 Cognitive Distraction
 American Driving Survey
 Senior Safety & Mobility – the LongROAD Study
 Cannabis studies

Drive Sharp – Brain Retraining for
Seniors
• Launched in 2009 in
collaboration
with Posit Science
• Computer based training
• Done at home
• Ten hours to complete
www.drivesharpnow.com

November 2015
Peter B. Delahunt, Ph.D.
Posit Science Corporation, San Francisco, CA.
Reducing auto crashes in real-world populations: A
direct demonstration of generalization of cognitive
training to functional abilities

A Brief Introduction to Posit Science
• Founded in 2003 to bring brain plasticity
out of the lab and into the world
• Spun out of UCSF
• Funded by leading venture capital
groups, NIH grants, and sales income
16
Where We
Came From
What We Do
Where We’re
Going
• Invent New Science: Apply brain
plasticity to build software-based
cognitive training programs that work
• Get Science to People: Build programs
that people love, and work with great
partners to reach millions of people
• Science to the people!
• Brain fitness as a core part of
everyone’s life

17
0
500
1000
1500
2000
2500
Crashes/100millionmilesdriven
AGE
AAAFTS report (2013) -- data from 2008-09
Younger and older drivers
have elevated crash risk.
Evidence that cognitive
training reduces crash risk in
older population. Potential for
teens.
AAA Foundation for Traffic
Safety (AAAFTS) were
interested in getting this
research into a real world
setting
Will discuss two current
projects with AAAFTS and
AAA clubs:
• Older drivers
• Teen drivers
Crash rates across lifespan show u-shaped
function – youngest and oldest are riskiest

18
Cognitive decline begins in our 30’s
and continues throughout life.
Slower visual processing and
reduced attentional capacity lead to
reductions in Useful Field of View
(UFOV). Developed by Drs. Karlene
Ball and Dan Roenker.
UFOV: The area over which you
can extract visual information at a
brief glance without head or eye
movement.
Drivers with poor UFOV twice as
likely to crash.
Older drivers with poor cognition are twice as
likely to crash
2.2
1.9
2.0
2.2
0.0
1.0
2.0
3.0
Owsley 1998 Sims 2000 Ball 2006 Rubin 2007
Relativecrashrisk

19
•Quicker reaction time - stop 22 feet sooner 55 mph (Roenker
et al., 2003).
•Reduced dangerous driving maneuvers by 36% (Roenker et
al., 2003).
•Maintained driving space and driving in difficult situations
(Edwards et al., 2009).
•Reduced risk of driver cessation by 40% in drivers with poor
UFOV (Edwards et al, 2009).
•Reduced at-fault crash incidences by ~50% in 5 years
following training (Ball et al, 2009).
UFOV training reduces crash risk in older
drivers

20
Exercise 1 (UFOV) Exercise 2 (MOT)
• Developed with Karlene Ball and Dan Roenker
• Online computer-based training
• 8 to 10 hours to complete
• Two exercises
• Engaging
Drivesharp development goal -- make UFOV
widely available and engaging

From Clinical Trials To Field Trials
Clinical trials are required
for establishing efficacy
• Carefully selected study
populations
• Tight control of program
use
• Random group
assignment
• Placebo controls
• Complex cognitive
function measures
• Blinded raters
21
Field studies are required for
establishing effectiveness
• Very broad study populations
• Very limited control of
program use
• Randomization typically
difficult or inappropriate
• Non-participant control groups
• Database derived outcome
measures from naturally
accruing data

22
Drivesharp project with AAAFTS / AAA
Offered by a number of AAA Clubs including
Auto Club of Southern California
Offered to auto policyholders age 55 plus
Incentive: 4.7% insurance discount for 3
years
Launched: March 2012
Registered: 20,736
Completers: 4,737 (23%)
Analysis plan

23
Red: pre-training
Blue: post-training
Completers only
~30% drop in claims rate
in first year
Booster training
Drivesharp analysis first look -- 30% drop in
crash rates

24
Search
Failures
Attention Issues
Inappropriate
Speed
• Inadequate search at junctions and before lane
changes
• Look away from road too long
• Maintaining focused attention on road
• Prone to distraction
• Too fast in low visibility conditions
40%
25%
25%
Teen drivers – main causes of crashes
0
500
1000
1500
2000
2500
Crashes/100millionmiles
driven
AGE

Attention and search under a range of
driving conditions Eye movements under cognitive load
Focused central attention while
monitoring periphery
• Online training
• 8-10 hours
• 3 exercises
• Embedded in metagame
InGear training software to reduce teen crash
risk

• Offered to teens of existing
policyholders (ages 15-19)
• Incentive: $100 on completion
• Parents can monitor progress
• Registrants 20,910
• Completers 3,348 (16%)
• Enough data to start analysis
• Analysis plan
26
InGear project with AAAFTS / AAA

Building neuroplasticity through live, online
mindfulness programs
Ruth Wolever, PhD
Chief Scientific Officer
ruth@emindful.com
(772) 569-4540
Some of our clients: Aetna Humana NextEra Energy State of Arizona

eMindful at a Glance
Only providerof live, online wellness programs that are:
• Built upon applied mindfulness, evidence-based & scalable
Over 6 years
working with
major national
health plans &
their clients

Overview
• Mindfulness and Applied Mindfulness Defined
• Background: Mindfulness in the Workplace
• What the Data Shows
• Implications for Neuroplasticity
Today’s presentation is 15 minutes.

Mindful
Awareness
Attitude
Key Elements of Mindfulness
“Paying
attention.”
“On
purpose.”
“In the present
moment, non-
judgmentally.”
Adapted from Shapiro et al. (2006). J Clin Psychol.

• Unhealthy lifestyle is driven by
numerous unhealthy habits that have
become default behaviors in our
environments
• Automatic pilot behaviors are mostly
outside of our awareness (cue followed
by series of behaviors, followed by
reward - linked in a neurological
pathway)
• Choice arises as participants notice and
understand how thoughts, emotions,
sensations and urges to act influence
behaviors
• By working with components separately,
strengthen ability to change perception,
emotional states, physiology and
behavior.
Applied Mindfulness

Decreased
Pain
Decreased
Anxiety &
Depression
Decreased Stress-
Related Medical
Symptoms
Improved
Attention
Improved Brain
Function &
Structure
Improved
Behaviors
Benefits of Mindfulness

At the time of the study, no published dissemination studies on mindfulness-
based workplace stress reduction programs
To be feasible for employees, must be easily accessible
Research: Mindfulness at Work
Background
Burgeoning literature evaluating
mind-body programs in clinical
settings
Minimal literature evaluating
mind-body programs in the work
place
At the time of the study, only 4
RCTs
(3 of them small)
No studies on use of virtual
classroom for health and
wellness experiential programs
Need to disseminate from the “Ivory
Towers” and Clinical Arenas

Used ITT principles and 2 (pre – post) X 2 (group) repeated
measures ANCOVA procedures
Baseline site differences within control group in race, ethnicity
and income so retained these as covariates in RM ANCOVAs
No baseline differences between Mindfulness at Work™ and
control groups in sociodemographics or key study variables
Research: Mindfulness at Work
Analysis: MAW versus Controls

Group X time interactions significant for:
PSS
[F(1,144) = 21.31,
P < .001]
Sleep quality
[F(1,144) = 5.17,
P < .05]
Mindfulness
[F(1,144) = 5.75,
P < .05]
Heart Rhythm
Coherence
[F(1,144) = 4.25,
P < .05]
Randomized Controlled Research: Mindfulness at Work
Results: MAW versus Controls

10 min resting
baseline pre-
intervention
4 min “stress preparation” period post-
intervention wherein participants were
instructed to prepare themselves mentally
and emotionally for an upcoming
important challenge
Calculated using interbeat intervals continuously sampled at
250 Hz during:
Difference between baseline and stress preparation
Randomized Controlled Research: Mindfulness at Work
Improvements in Heart Rhythm Coherence

Randomized Controlled Research: Would the program be
as effective online in a virtual classroom?
Used ITT principles and 2
(time) X 2 (group) repeated
measures ANCOVA
procedures
Race, ethnicity and income
again retained as covariates
since baseline differences
across venues (online vs in-
person) in income, and in all
3 sociodemographic
variables across sites

No group X time interactions for PSS, sleep quality,
mindfulness, depressive symptoms or work productivity
Significant group X time interaction for Heart Rhythm
Coherence [F(1,91) = 3.91, p < .05]; online group showed
greater improvement
Likely due to attrition differences
Randomized Controlled Research:
Results: MAW Online versus In-Person

Randomized Controlled Research:
Mindfulness at Work
Attrition
 The online mindfulness group had an extremely low
attrition rate (4%)
 Significantly lower than the attrition for the in-person
group (27%), which was more typical for behavioral
trials
 No differences in attrition between MAW and
controls
 No baseline differences between attriters and
completers

In terms of outcomes, delivery through a virtual classroom was
as effective as in-person delivery.
Online classes had significantly higher completion rate.
Perhaps the better retention rate in the online group related
to digital opportunities to view the class at later, more
convenient times. This needs further study.

Financially Positive
"...we saw dramatic drops … we saw a
$3,000 reduction in their healthcare costs
for the next year."
- Mark Bertolini, CEO Aetna

Decreased amygdala density after Mindfulness-Based
Stress Reduction (MBSR)
From Hölzel et al. (2010). SCAN
Reductions in right amygdala gray matter density correlate with
changes in perceived stress; the more someone lowered their
stress, the more neuroplastic change observed after a course of
mindfulness training.

MBSR alters functional connectivity
From Kilpatrick et al. (2011) NeuroImage

 For individuals, training in mindfulness through a virtual classroom
lowers stress (perceptually & biologically), enhances sleep, and improves
neuroplasticity. Smart phones now allow increased access and
convenience to eMindful programs.
 For employers, results are seen in the bottom line – greater productivity,
lower heatlhcare costs, employees that can focus and learn more
effectively
Bottom Line

To “Enhance Work and Life,” Listen to the Life Stories Outside the Data
“This class...has been life-changing for me. I know I
am a better mother. I know I’m a better wife. I know
that I’m a better daughter because of this class. And
my goals are to continue using the teachings that I
have learned, even without the continued support of
everyone else in the class…”

Mindful Awareness
Course participants see powerful results
Reduced stress Stopped smoking
29 Reversed metabolic
syndrome
5540
Gain in productivity
per week
47% %%mins

Since 2007
We have helped thousands
of people, in more than
135 countries, with important
issues such as stress,
smoking, diabetes, cancer,
chronic pain and metabolic
health.

50/42Click to edit Master title style
Cognitive Simulation
in the service of
Competitive Sports
Danny Dankner, CEO
ACE Applied Cognitive Engineering, Inc.

51/42Click to edit Master title styleFocus: Targeted Training (Profession / Task)

52/42Click to edit Master title styleComplex Cognitive System

53/42Click to edit Master title styleCompetitive Sports Arena
Extreme value to performance enhancement
Rich in statistics, efficacy highly visible
Clear need; missing training protocol

Mapping the cognitive skill-set of the
specific domain
(e.g.: Hand eye coordination, Attention,
Decision making, Perception, Spatial orientation)
Training the cognitive skill-set via
Cognitive Simulation
US Patent Number 7887239
ACE’s Patented Technology: Cognitive Simulation
5 Habanai St., Hod Hasharon,



55/42Click to edit Master title styleReading the Game

Actual Training Environment

Demonstrating Various Training Scenarios
Clouds – partial hiding Long threat
Moving goals Spotlight

63/42Click to edit Master title styleMembers Area – Reports Module

64/42Click to edit Master title styleThe Hockey IntelliGym – Case Study

65/42Click to edit Master title styleResults in Ice-Hockey: International Titles!
Year Gold Silver Bronze
1999 Finland Sweden Slovakia
2000 Finland Russia Sweden
2001 Russia Switzerland Finland
2002 USA Russia Czech Rep.
2003 Canada Slovakia Russia
2004 Russia USA Czech Rep.
2005 USA Canada Sweden
2006 USA Finland Czech Rep.
2007 Russia USA Sweden
2008 Canada Russia USA
2009 USA Russia Finland
2010 USA Sweden Finland
2011 USA Sweden Russia
2012 USA Sweden Canada
2013 Canada USA Finland
2014 USA Czech Rep. Canada
2015 USA Finland Canada
ICE HOCKEY U18
WORLD
CHAMPIONSHIP

66/42Click to edit Master title styleResults in Ice-Hockey: International Titles!
USA U18 National Team
adopts the IntelliGym.
Goals per Player
increased by 42%
Year Gold Silver Bronze
1999 Finland Sweden Slovakia
2000 Finland Russia Sweden
2001 Russia Switzerland Finland
2002 USA Russia Czech Rep.
2003 Canada Slovakia Russia
2004 Russia USA Czech Rep.
2005 USA Canada Sweden
2006 USA Finland Czech Rep.
2007 Russia USA Sweden
2008 Canada Russia USA
2009 USA Russia Finland
2010 USA Sweden Finland
2011 USA Sweden Russia
2012 USA Sweden Canada
2013 Canada USA Finland
2014 USA Czech Rep. Canada
2015 USA Finland Canada
ICE HOCKEY U18
WORLD
CHAMPIONSHIP

67/42Click to edit Master title styleOur Vision:
IntelliGymTM
brain workout is a part of the training
routine of every competitive athlete.

© 2015 EDGE Innovation Network. All rights reserved.© 2015 EDGE Innovation Network. All rights reserved.
Challenges with Current
Measurement Tools
1. A majority of the cognitive measurement systems were designed to
identify differences as they relate to injury, disease and mental
disorders. They weren’t used to identify the different types of
‘normal’.
2. These tools were developed largely from assessment of men not
women.
3. A majority of the military cognitive tools that are used/accepted are
based on1980s technology or earlier.
4. Since most of the tools have dealt with abnormal behavior
conditions, and primarily for medical purposes, regulations like
HIPAA regulations creates a significant burden on information
sharing.
12/3/2015Introduction to the EDGE® | What is the EDGE® and How Does it Work? 69

TFA Rating
Think
Executive Function
Fluid Intelligence
Circadian Rhythm
Grit/Drive
Experience/Crystalline
Intelligence
Moral/Ethics
Feels
Resilience
Outlook
Social Intuition
Self-Awareness
Sensitivity to
Context
Attention
Acts
Fact Finder
Follow Thru
Quick Start
Implementer

Using the TFA Rating
1. Self Assessment or Baselining
2. Training and Education
3. Capabilities Development of KSA/KPP
4. Industry Production Range
5. Development of Cognitive Aide and Augmentation Tools
6. Leader Tools and Processes for Cognitive Operational
Readiness

Summit is on a short
“Bio” Break.
(we will resume at 10:00am Pacific Time)
Chat forums will be available during the Watercooler session

To learn more, visit sharpbrains.com

Brain Health in the Pervasive Neurotechnology Era

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