Games are usually associated with a dearth of productivity, but since the beginning of this decade there has been a growing movement to apply them to solve real-world problems such as improving patient health. Most of these games rely on a graphical user interface (GUI), but we recently learned of a new type of gameplay being developed called the tangible user interface (TUI). CogCubed is applying the TUI to help diagnose and eventually offer treatment to patients with ADHD and other cognitive issues, especially those related to executive functioning. They recently announced a Phase II clinical trial with Johns Hopkins among other institutions to test their technology. We had an opportunity to ask their Founder and CEO, Kurt Roots, a few questions about what the company is up to.
Shiv Gaglani, Medgadget: What does CogCubed do?
Kurt Roots: CogCubed makes games to identify and treat cognitive disorders like attention deficit hyperactivity disorder (ADHD). We are using new multisensory gaming platforms to capture large amounts of objective behavioral data but also engage people differently. By playing our games, clinicians, educators, and consumers can understand and improve cognitive health. We have developed a 30 minute game, designed specifically for children and adolescents, to assess deficits in attention commonly found in ADHD. While we are still validating the technology through clinical research, we intend to eventually distribute it to both clinicians and consumers. Other games we have designed are geared towards brain training, or treatment. Based on concepts of neuroplasticity, we are working with schools and consumers to help monitor and improve cognitive health.
Medgadget: Tell us about the technology.
Kurt Roots: Our games predominantly utilize new technology from the MIT Media Lab which consists of small cube computers that contain multiple sensors, which allow children to hold and play with the cubes as they solve problems posed in the game. The interactive and tangible nature of this system has the potential to increase engagement, optimizing learning for children.
These physical blocks represent a Tangible User Interface (TUI), a recent advance in technology and games. TUIs represent physical manifestations which manipulate digital data by actually representing physical blocks, which can be neighbored and moved and contain the components of miniature computers. This bridges the gap between physical and digital worlds. A growing body of research in exploring uses of tangible systems for children shows that such interfaces encourage collaboration, playfulness and engagement. Studies have also shown that TUIs are easier to learn than traditional graphical user interfaces (GUIs), increase problem solving behaviors, and improve spatial cognition. These make the cubes an attractive platform for therapeutic games.
Medgadget: Why cubes and not something else?
Kurt Roots: While we recognize the importance of the spatial capabilities and tangible nature of the cubes, we have closely analyzed other form factors to measure attention and memory. As the number of sensors in mobile and tablet devices increases, we believe our data capture mechanisms and algorithms used in predictive analysis from behavior will be portable. The cubes are currently far ahead of that curve.
Medgadget: Who is your target customer?
Kurt Roots: The end goal is to get this in front of as many people who need it most. The prescriber of most ADHD medications, which totaled $9 billion in sales in 2012, is pediatricians. We know that in 2007 a CDC study showed 5.4 million kids were diagnosed with ADHD. A 2010 study found that about 1 million kids have been misdiagnosed. That is a huge number that could be reduced. Therefore, our focus right now is validating the technology and the approach and then getting this objective tool out to clinicians.
Medgadget: What research have you done and what’s the plan there?
Kurt Roots: Thus far, we have completed a pilot study assessing our game Groundskeeper as an ADHD assessment tool. We captured game play responses from 52 children and adolescents, 26 with ADHD and 26 without. Data was captured at several outpatient clinics and the analysis was performed at the University of Minnesota. The results were very encouraging, showing that based on game play, we were able to differentiate between treatment and control populations. Specifically, our game could accurately detect the condition 75% to 78% of the time, compared to existing methods which are roughly 60% accurate. We are ramping up for another phase of this clinical research, validating our game as an effective tool for assessing ADHD.
Medgadget: Tell us about your business model.
Kurt Roots: The game will initially be rolled out to clinicians and we will seek reimbursement through existing CPT codes. Because we have been contacted by a lot of consumers and concerned parents, we will make a version available to consumers as well. The goal there is to provide something that is low-cost and ‘good enough’ for home use.
Medgadget: What other health conditions can this be applied to?
Kurt Roots: When we started CogCubed, we wanted to avoid labels of conditions and just focus on executive functioning deficits. Our pilot study actually looked at a range of these, including ADHD, Anxiety, Depression, and Autism Spectrum Disorder (ASD). However, to bring this to market in a meaningful and effective way, we decided to first focus on one specific condition, hence most of our research has been around this to date. However, this technology could be applied to Anxiety, Depression, ASD, traumatic brain injuries (TBIs), and even Alzheimer’s.
Medgadget: Tell us about the regulatory path and why you are pursuing it.
Kurt Roots: We really want to be evidence-based, and are therefore pursuing FDA approval for our game, which assesses ADHD. This is considered a 510(k). We have been working closely with the FDA on research protocols ensuring that what we are doing is properly regulated. While we don’t actually need FDA approval to sell this in the market, we believe that the cost is low enough and the value is high enough to justify the exercise.
Medgadget: Do you have any intellectual property protection?
Kurt Roots: We have 3 patents which focus on our methods to capture, store, and analyze behavioral data from multisensory devices. While we did not invent the cubes, we repurposed the technology to granularly capture new types of data, which are based on neurological correlates. These brain-to-behavior mappings manifest themselves in this data set, which we then analyze through machine learning techniques. This is an entirely new way to consider assessing and improving mental health conditions.
Medgadget: Describe why design has been a priority for you.
Kurt Roots: When someone is done playing our game, data is wirelessly uploaded online to a portal. We carefully considered the existing methods used to assess a broad range of mental health disorders. Most of these are subjective, so there isn’t a lot of useful information that needs presenting. The objective tools typically provide reports, or ‘printouts’ designed for highly trained professionals. We wanted to do something different, by providing a web portal that can be seen and utilized by providers, parents and/or patients. It made sense to partner with a human-centered design firm like Azul 7 because they are experts in taking a lot of data, disseminating it, and understanding what is useful for people to actually use this tool to find value. We still provide the ‘printouts’, but you don’t need to have a PhD to understand it.
Medgadget: How has Azul 7 impacted usability?
Kurt Roots: The challenge with creating a new tool that captures data every 1/10 of a second for 30 minutes, for 30 different variables, is that you end up with way to much information for humans to interpret. Azul 7 forced us to think critically about the metrics and analysis displayed from our game for these multiple constituents.