It applications that support aging in place seven categories of need
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IT applications that support aging in place: seven categories of need. Mike Rosen Outgoing Director Rehabilitation Engineering Labs National Rehabilitation Hospital.

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It applications that support aging in place seven categories of need

IT applications that support aging in place:seven categories of need

Mike Rosen

Outgoing Director

Rehabilitation Engineering Labs

National Rehabilitation Hospital

Disclaimer: This talk is about meeting the needs of elders by using technology. Therefore it will focus on technology. It is, however, the position of the speaker, his colleagues and family that IT must be applied in the context of an integrated consumer-centered system of health care and support for independent living.


Seven killer app s that support life and living
Seven killer app’s that support life and living

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication with the outside

  • Access to information and stimulation

Note: first three are about service delivery; last three are assistive; fourth one can be either depending on one’s model of health care.


First application
First application …

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication with the outside

  • Access to information and stimulation

Talking Lights


For example
For example:

  • Critical medical events (e.g. stroke, coronary, diabetic coma)

    • incapacitated

    • some capacities intact

  • Falls

    • conscious but immobile

      • at home

      • away

    • unconscious

      • at home

      • away

  • Wandering (secondary to dementia)

    • aware

    • unaware

Note 1: Engineering challenges vary dramatically across these examples; e.g. sensor integration and knowledge-based processing for automated fall detection.

Note 2: Automated solutions must take into account the costs of false positives and false negatives.


Second application
Second application …

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication with the outside

  • Access to information and stimulation


For example1

Note 1: This kind of instrumented monitoring may be felt as less intrusive than video.

Note 2: Wireless solutions are nearly essential.

Note 3: Either modular retro-fittable senor products (like X10) or “smart home” integrated systems*.

For example:

  • Detection, timing, counting of environmental use, e.g. bed, chair, bathroom use …

    • to sample elder’s energy and engagement

    • to note indications of depression

    • to track the progress of rehab or disease state

  • In situ motion analysis

    • Crude cumulative accelerometry for overall (“Actigraphs”)

    • Targeted processing of wearable sensor signals to detect/measure particular symptoms, e.g. tremor, spasticity, o.c.d. …

*MIT, GA Tech, Intel, GE, Rochester


Third application
Third application … less intrusive than video.

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication with the outside

  • Access to information and stimulation


It applications that support aging in place seven categories of need

the premise… less intrusive than video.

  • Unobtrusive monitoring of selected ADL’s in the home is technically feasible and practical.

  • Performance of ADLs is the most direct and ecologically valid indicator of functional status (and rehab outcome).

  • ADL event time records can be processed to return meaningful estimates of global functional status for display to OTs and other remote service providers …

  • without video


Nrh project design
NRH project design … less intrusive than video.

  • First: develop and demonstrate a prototype sensor package and data-acquisition hardware and software for installation in a kitchen: done

“Wired Independence Square” at NRH


Unobtrusive sensors so far just switches

micro-switch less intrusive than video.

unobtrusivesensors: so far just switches

Is the stove on?

in-line

flow switch

magnetic proximity switch

Is the faucet running?

Is the cabinet open?


Project design
project design … less intrusive than video.

  • Then: formulate and validate estimators

    • Hypothesize performance metrics (PMs) based on timing and counting

    • Regress linear combinations of PMs against AMPS sub-scores (as the validated standard measure) across subjects

    • Test the hypothesis: look for correlations between PMs and AMPS scores; i.e. show that our objective automated sampling of selected task performance can estimate overall function


Possible performance metrics
possible performance metrics … less intrusive than video.

  • Durations, e.g. event-to-event

  • Counts, e.g. # times refrigerator was opened

  • Categorical: yes/no

  • Spatial distance moved

  • Rates, events per time

  • Normalized by optimal or norm or “contract” with therapist


Status
status … less intrusive than video.

  • Sensor package in place in Independence Square at NRH …

  • with funding from NIDRR via the RERC on Telerehab, and from the U.S. Army Medical Research and Materiel Command

  • OT research partner, trained in AMPS (Assessment of Motor and Process Skills), has tested five subjects with left CVA

  • In-home validation studies proposed, both cross-subject and longitudinal


Development plan
development plan … less intrusive than video.

  • Bring to market the CARE package (Collection of Adls for Remote Evaluation):

    • Wireless switch package

    • Data logging and transfer box (H.323 protocol)

    • Hub-site data capture and processing software

    • Interactive display software for OTs and other service providers


Fourth application
Fourth application … less intrusive than video.

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication with the outside

  • Access to information and stimulation


For example2

* less intrusive than video.MIT MANUS, Greg Burdea’s hand and foot systems, Dave Reinkensmeyer’s Java Therapy

For example:

  • Sensing of medication use and prescribed therapeutic activities to monitor compliance

  • “Home health technology” for regular sampling of physiological signals and video visits

    • integrated into home environment, e.g. the smart toilet

    • special purpose table-top

    • wearable

    • implanted

  • Telerehab, e.g.

    • speech pathology

    • psychological counseling

    • neuropsych evaluation

    • wound management

    • assistive technology assessment

    • follow-up post-discharge

    • web-enabled video-enhanced robotic PT*

Note 1: an engineering challenge is the processing of instrumentation signals to yield clinician-friendly results; OR educate clinicians to be instrumentation-friendly

Note 2: always-on streaming video monitoring may be viewed as Big Brother by some, Guardian Angel by others.


Fifth application
Fifth application … less intrusive than video.

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication with the outside

  • Access to information and stimulation


For example3

Note: this need is less intrusive than video.not limited to elders. This is universal assistive technology.

For example:

  • Application of mass-market technologies such as PDA’s and GPS

  • Purpose-designed software and human interfaces* for prompting during home-based ADL’s, e.g. cooking: “cognitive orthoses”

  • Integrated smart home solutions, e.g. networking contents-monitoring refrigerator with shopping service; or digital voice prompts about safety issues such as door locking or remembering to shut off the stove

*Elliot Cole, Institute for Cognitive Prosthetics


Sixth application
Sixth application … less intrusive than video.

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication with the outside

  • Access to information and stimulation


For example4
For example: less intrusive than video.

  • Phone

  • Email, instant messaging, …

  • Cell-phone-based short text message service

  • Televisits with remote family (via H.324 videophones; H.323 Internet-based standard; or coming 3G video cell phones)

  • Special-interest chat rooms, blogs, …

  • On-line photo albums

  • Web-based advocacy

    and politics

  • Amazon.com etc.

Note: Evidence is convincing that old age itself is not a barrier to use of sophisticated IT. The habits, expectations, experience and attitudes of this particular generation of elders can be.


Seventh application
Seventh application … less intrusive than video.

  • Emergency detection and response-cuing

  • Activity tracking for status monitoring

  • Task sampling for status monitoring

  • Health maintenance

  • Cognitive support in ADL’s

  • Enhanced communication to the outside

  • Access to information and stimulation

ARMCHAIR TRAVEL.COM


For example5
For example: less intrusive than video.

  • Unlimited access to all interest areas via specialty Web sites

  • Virtual travel

  • On-line news and other publications

  • Health information Web sites

  • Internet-based music browsing and downloading


More notes
More notes: less intrusive than video.

  • The majority of the products noted here are sold to the mass market. Elders are themselves a huge and growing market; but many of these IT app’s or their core technologies suit virtually the entire population.

  • In telehealth, communication and cognitive support, mass-market convergence products can become specialty tools -- 3G video smart phones, for example, for telehealth.


It applications that support aging in place seven categories of need

New Yorker Cartoon by Gregory less intrusive than video.

Swissmemory USB by Victorinox