SoM: a smart sensor for human activity monitoring and assisted healthy ageing

Using Smart Home Technologies to Promote Physical Activity Among the General and Aging Populations: Scoping Review

BACKGROUND

Health-monitoring smart homes are becoming popular, with experts arguing that 9-to-5 health care services might soon become a thing of the past. However, no review has explored the landscape of smart home technologies that aim to promote physical activity and independent living among a wide range of age groups.

OBJECTIVE

This review aims to map published studies on smart home technologies aimed at promoting physical activity among the general and aging populations to unveil the state of the art, its potential, and the research gaps and opportunities.

METHODS

Articles were retrieved from 6 databases (PubMed, CINAHL, Scopus, IEEE Xplore, ACM Library, and Web of Science). The criteria for inclusion were that the articles must be user studies that dealt with smart home or Active Assisted Living technologies and physical activity, were written in English, and were published in peer-reviewed journals. In total, 3 researchers independently and collaboratively assessed the eligibility of the retrieved articles and elicited the relevant data and findings using tables and charts.

RESULTS

This review synthesized 20 articles that met the inclusion criteria, 70% (14/20) of which were conducted between 2018 and 2020. Three-quarters of the studies (15/20, 75%) were conducted in Western countries, with the United States accounting for 25% (5/20). Activities of daily living were the most studied (9/20, 45%), followed by physical activity (6/20, 30%), therapeutic exercise (4/20, 20%), and bodyweight exercise (1/20, 5%). K-nearest neighbor and naïve Bayes classifier were the most used machine learning algorithms for activity recognition, with at least 10% (2/20) of the studies using either algorithm. Ambient and wearable technologies were equally studied (8/20, 40% each), followed by robots (3/20, 15%). Activity recognition was the most common goal of the evaluated smart home technologies, with 55% (11/20) of the studies reporting it, followed by activity monitoring (7/20, 35%). Most studies (8/20, 40%) were conducted in a laboratory setting. Moreover, 25% (5/20) and 10% (2/20) were conducted in a home and hospital setting, respectively. Finally, 75% (15/20) had a positive outcome, 15% (3/20) had a mixed outcome, and 10% (2/20) had an indeterminate outcome.

CONCLUSIONS

Our results suggest that smart home technologies, especially digital personal assistants, coaches, and robots, are effective in promoting physical activity among the young population. Although only few studies were identified among the older population, smart home technologies hold bright prospects in assisting and aiding older people to age in place and function independently, especially in Western countries, where there are shortages of long-term care workers. Hence, there is a need to do more work (eg, cross-cultural studies and randomized controlled trials) among the growing aging population on the effectiveness and acceptance of smart home technologies that aim to promote physical activity.

IoT Smart Flooring Supporting Active and Healthy Lifestyles

The lack of physical exercise is among the most relevant factors in developing health issues, and strategies to incentivize active lifestyles are key to preventing these issues. The PLEINAIR project developed a framework for creating outdoor park equipment, exploiting the IoT paradigm to build "Outdoor Smart Objects" (OSO) for making physical activity more appealing and rewarding to a broad range of users, regardless of their age and fitness. This paper presents the design and implementation of a prominent demonstrator of the OSO concept, consisting of a smart, sensitive flooring, based on anti-trauma floors commonly found in kids playgrounds. The floor is equipped with pressure sensors (piezoresistors) and visual feedback (LED-strips), to offer an enhanced, interactive and personalized user experience. OSOs exploit distributed intelligence and are connected to the Cloud infrastructure by using a MQTT protocol; apps have then been developed for interacting with the PLEINAIR system. Although simple in its general concept, several challenges must be faced, related to the application range (which called for high pressure sensitivity) and the scalability of the approach (requiring to implement a hierarchical system architecture). Some prototypes were fabricated and tested in a public environment, providing positive feedback to both the technical design and the concept validation.

Human Activity Recognition System For Moderate Performance Microcontroller Using Accelerometer Data And Random Forest Algorithm

There has been increasing interest in the application of artificial intelligence technologies to improve the quality of support services in healthcare. Some constraints, such as space, infrastructure, and environmental conditions, present challenges with assistive devices for humans. This paper proposed a wearable-based real-time human activity recognition system to monitor daily activities. The classification was done directly on the device, and the results could be checked over the internet. The accelerometer data collection application was developed on the device with a sampling frequency of 20Hz, and the random forest algorithm was embedded in the hardware. To improve the accuracy of the recognition system, a feature vector of 31 dimensions was calculated and used as an input per time window. Besides, the dynamic window method applied by the proposed model allowed us to change the data sampling time (1-3 seconds) and increase the performance of activity classification. The experiment results showed that the proposed system could classify 13 activities with a high accuracy of 99.4%. The rate of correctly classified activities was 96.1%. This work is promising for healthcare because of the convenience and simplicity of wearables.

Non-invasive dual attention TCN for electromyography and motion data fusion in lower limb ambulation prediction

OBJECTIVE

Recent technological advances show the feasibility of fusing surface electromyography (sEMG) signals and movement data to predict lower limb ambulation intentions. However, since the invasive fusion of different signals is a major impediment to improving predictive performance, searching for a non-invasive fusion mechanism for lower limb ambulation pattern recognition based on different modal features is crucial.

APPROACH

We propose an end-to-end sequence prediction model with non-invasive dual attention temporal convolutional networks (NIDA-TCN) as a core to elegantly address the essential deficiencies of traditional decision models with heterogeneous signal fusion. Notably, the NIDA-TCN is a weighted fusion of sEMG and inertial measurement units (IMU) with time-dependent effective hidden information in the temporal and channel dimensions using TCN and self-attentive mechanisms. The new model can better discriminate between walking, jumping, downstairs, and upstairs four lower limb activities of daily living (ADL).

MAIN RESULTS

The results of this study show that the NIDA-TCN models produce predictions that significantly outperform both frame-wise and TCN models in terms of accuracy, sensitivity, precision, F1 score, and stability. Particularly, the NIDA-TCN with sequence decision fusion (NIDA-TCN-SDF) models, have maximum accuracy and stability increments of 3.37% and 4.95% relative to the frame-wise model, respectively, without manual feature-encoding and complex model parameters.

SIGNIFICANCE

It is concluded that the results demonstrate the validity and feasibility of the NIDA-TCN-SDF models to ensure the prediction of daily lower limb ambulation activities, paving the way to the development of fused heterogeneous signal decoding with better prediction performance.

The Impact of Healthcare 4.0 on the Healthcare Service Quality: A Systematic Literature Review

Healthcare 4.0 is inspired by Industry 4.0 and its application has resulted in a paradigmatic shift in the field of healthcare. However, the impact of this digital revolution in the healthcare system on healthcare service quality is not known. The purpose of this study is to examine the impact of healthcare 4.0 on healthcare service quality. This study used the systematic literature review methodology suggested by Transfield et al. to critically examine 67 articles. The impact of healthcare 4.0 is analyzed in-depth in terms of the interpersonal, technical, environmental, and administrative aspect of healthcare service quality. This study will be useful to hospitals and other stakeholders to understand the impact of healthcare 4.0 on the service quality of health systems. Besides, this study critically analyses the existing literature and identifies research areas in this field and hence will be beneficial to researchers. Though there are few literature reviews in healthcare 4.0, this is the first study to examine the impact of Healthcare 4.0 on healthcare service quality.

A Sensor-Based mHealth Platform for Remote Monitoring and Intervention of Frailty Patients at Home

Frailty syndrome is an independent risk factor for serious health episodes, disability, hospitalization, falls, loss of mobility, and cardiovascular disease. Its high reversibility demands personalized interventions among which exercise programs are highly efficient to contribute to its delay. Information technology-based solutions to support frailty have been recently approached, but most of them are focused on assessment and not on intervention. This paper describes a sensor-based mHealth platform integrated in a service-based architecture inside the FRAIL project towards the remote monitoring and intervention of pre-frail and frail patients at home. The aim of this platform is constituting an efficient and scalable system for reducing both the impact of aging and the advance of frailty syndrome. Among the results of this work are: (1) the development of elderly-focused sensors and platform; (2) a technical validation process of the sensor devices and the mHealth platform with young adults; and (3) an assessment of usability and acceptability of the devices with a set of pre-frail and frail patients. After the promising results obtained, future steps of this work involve performing a clinical validation in order to quantify the impact of the platform on health outcomes of frail patients.

Clinical application of the experimental ADL test for patients with cognitive impairment: pilot study

We employed a hospital-based Internet of Things (IoT) platform to validate the role of real-time activities of daily living (ADL) measurement as a digital biomarker for cognitive impairment in a hospital setting. Observational study. 12 patients with dementia, 11 patients with mild cognitive impairment (MCI), and 15 cognitively normal older adults. The results of 13 experimental ADL tasks were categorized into success or fail. The total number of successful task and the average success proportion of each group was calculated. Time to complete the total tasks was also measured. Patients with dementia, patients with MCI, and cognitively normal older adults performed 13 experimental ADL tasks in a hospital setting. Significant differences in the average success rate of 13 tasks were found among groups. Dementia group showed the lowest success proportion (49.3%) compared with MCI group (78.3%) and normal group (97.4%). Correlation between classical ADL scales and the number of completed ADL tasks was statistically significant. In particular, instrumental ADL (I-ADL) had stronger relationship with the number of completed ADL tasks than Barthel's ADL (B-ADL). Dementia group required more time to accomplish the tasks when compared to MCI and normal groups. This study demonstrated that there is a clear relationship between the performance of experimental ADL tasks and the severity of cognitive impairment. The evaluation of ADLs involving the IoTs platform in an ecological setting allows accurate assessment and quantification of the patient's functional level.

Analysis of factors affecting IoT-based smart hospital design

Currently, rapidly developing digital technological innovations affect and change the integrated information management processes of all sectors. The high efficiency of these innovations has inevitably pushed the health sector into a digital transformation process to optimize the technologies and methodologies used to optimize healthcare management systems. In this transformation, the Internet of Things (IoT) technology plays an important role, which enables many devices to connect and work together. IoT allows systems to work together using sensors, connection methods, internet protocols, databases, cloud computing, and analytic as infrastructure. In this respect, it is necessary to establish the necessary technical infrastructure and a suitable environment for the development of smart hospitals. This study points out the optimization factors, challenges, available technologies, and opportunities, as well as the system architecture that come about by employing IoT technology in smart hospital environments. In order to do that, the required technical infrastructure is divided into five layers and the system infrastructure, constraints, and methods needed in each layer are specified, which also includes the smart hospital’s dimensions and extent of intelligent computing and real-time big data analytic. As a result of the study, the deficiencies that may arise in each layer for the smart hospital design model and the factors that should be taken into account to eliminate them are explained. It is expected to provide a road map to managers, system developers, and researchers interested in optimization of the design of the smart hospital system.

Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review

Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.

BIA: Behavior Identification Algorithm Using Unsupervised Learning Based on Sensor Data for Home Elderly

Behavior identification plays an important role in supporting homecare for the elderly living alone. In literature, plenty of algorithms have been designed to identify behaviors of the elderly by learning features or extracting patterns from sensor data. However, most of them adopted probabilistic models or supervised learning to identify behaviors based on labeled sensor data. This paper proposes a behavior identification algorithm (BIA) using unsupervised learning based on unlabeled sensor data for the elderly living alone in smart home. This paper presents the observation of elder behaviors with three features: Event Order, Time Length Similarity and Time Interval Similarity features. Based on these features of behavior observations, two properties of behaviors, including the Event Shift and Histogram Shape Similarity properties, are presented. According to these properties, the proposed BIA is developed. Finally, performance results show that the proposed BIA outperforms the existing unsupervised machine learning mechanisms in terms of the behavior identification precision and recall.

An Acoustic-Based Smart Home System for People Suffering from Dementia

Aging-in-place can reduce the progress of dementia syndrome and improve the quality of life of the sufferers and their families. Taking into consideration the fact that numerous neurological research results suggest the use of sound as a stimulus for empowering the memory of the sufferer, an innovative information home support system for people suffering from dementia is proposed. The innovation of the proposed system is found in its application, that is to integrate a home system for assisting with person recognition via a sound-based memory aid service. Furthermore, the system addresses the needs of people suffering from dementia to recognize their familiars and have better interaction and collaboration, without the need for training. The system offers a ubiquitous recognition system, using smart devices like smart-phones or smart-wristbands. When a familiar person is detected in the house, then a sound is reproduced on the smart speakers, in order to stimulate the sufferer’s memory. The system identified all users and reproduced the appropriate sound in 100% of the cases. To the best of the authors’ knowledge, this is the first system of its kind for assisting person recognition via sound ever reported in the literature.

Implicit Irregularity Detection Using Unsupervised Learning on Daily Behaviors

The irregularity detection of daily behaviors for the elderly is an important issue in homecare. Plenty of mechanisms have been developed to detect the health condition of the elderly based on the explicit irregularity of several biomedical parameters or some specific behaviors. However, few research works focus on detecting the implicit irregularity involving the combination of diverse behaviors, which can assess the cognitive and physical wellbeing of elders but cannot be directly identified based on sensor data. This paper proposes an Implicit IRregularity Detection (IIRD) mechanism that aims to detect the implicit irregularity by developing the unsupervised learning algorithm based on daily behaviors. The proposed IIRD mechanism identifies the distance and similarity between daily behaviors, which are important features to distinguish the regular and irregular daily behaviors and detect the implicit irregularity of elderly health condition. Performance results show that the proposed IIRD outperforms the existing unsupervised machine-learning mechanisms in terms of the detection accuracy and irregularity recall.

Human activity monitoring system based on wearable sEMG and accelerometer wireless sensor nodes

Background

The human activity monitoring technology is one of the most important technologies for ambient assisted living, surveillance-based security, sport and fitness activities, healthcare of elderly people. The activity monitoring is performed in two steps: the acquisition of body signals and the classification of activities being performed. This paper presents a low-cost wearable wireless system specifically designed to acquire surface electromyography (sEMG) and accelerometer signals for monitoring the human activity when performing sport and fitness activities, as well as in healthcare applications.

Results

The proposed system consists of several ultralight wireless sensing nodes that are able to acquire, process and efficiently transmit the motion-related (biological and accelerometer) body signals to one or more base stations through a 2.4 GHz radio link using an ad-hoc communication protocol designed on top of the IEEE 802.15.4 physical layer. A user interface software for viewing, recording, and analysing the data was implemented on a control personal computer that is connected through a USB link to the base stations. To demonstrate the capability of the system of detecting the user’s activity, data recorded from a few subjects were used to train and test an automatic classifier for recognizing the type of exercise being performed. The system was tested on four different exercises performed by three people, the automatic classifier achieved an overall accuracy of 85.7% combining the features extracted from acceleration and sEMG signals.

Conclusions

A low cost wireless system for the acquisition of sEMG and accelerometer signals has been presented for healthcare and fitness applications. The system consists of wearable sensing nodes that wirelessly transmit the biological and accelerometer signals to one or more base stations. The signals so acquired will be combined and processed in order to detect, monitor and recognize human activities.

Examining sensor-based physical activity recognition and monitoring for healthcare using Internet of Things: A systematic review

Due to importantly beneficial effects on physical and mental health and strong association with many rehabilitation programs, Physical Activity Recognition and Monitoring (PARM) have been considered as a key paradigm for smart healthcare. Traditional methods for PARM focus on controlled environments with the aim of increasing the types of identifiable activity subjects complete and improving recognition accuracy and system robustness by means of novel body-worn sensors or advanced learning algorithms. The emergence of the Internet of Things (IoT) enabling technology is transferring PARM studies to open and connected uncontrolled environments by connecting heterogeneous cost-effective wearable devices and mobile apps. Little is currently known about whether traditional PARM technologies can tackle the new challenges of IoT environments and how to effectively harness and improve these technologies. In an effort to understand the use of IoT technologies in PARM studies, this paper will give a systematic review, critically examining PARM studies from a typical IoT layer-based perspective. It will firstly summarize the state-of-the-art in traditional PARM methodologies as used in the healthcare domain, including sensory, feature extraction and recognition techniques. The paper goes on to identify some new research trends and challenges of PARM studies in the IoT environments, and discusses some key enabling techniques for tackling them. Finally, this paper consider some of the successful case studies in the area and look at the possible future industrial applications of PARM in smart healthcare.

Classifier Level Fusion of Accelerometer and sEMG Signals for Automatic Fitness Activity Diarization

The human activity diarization using wearable technologies is one of the most important supporting techniques for ambient assisted living, sport and fitness activities, healthcare of elderly people. The activity diarization is performed in two steps: the acquisition of body signals and the classification of activities being performed. This paper presents a technique for data fusion at classifier level of accelerometer and sEMG signals acquired by using a low-cost wearable wireless system for monitoring the human activity when performing sport and fitness activities, as well as in healthcare applications. To demonstrate the capability of the system of diarizing the user's activities, data recorded from a few subjects were used to train and test the automatic classifier for recognizing the type of exercise being performed.

Cognitive impairment categorized in community-dwelling older adults with and without dementia using in-home sensors that recognise activities of daily living

Cognitive impairment due to dementia decreases functionality in Activities of Daily Living (ADL). Its assessment is useful to identify care needs, risks and monitor disease progression. This study investigates differences in ADL pattern-performance between dementia patients and healthy controls using unobtrusive sensors. Around 9,600 person-hours of activity data were collected from the home of ten dementia patients and ten healthy controls using a wireless-unobtrusive sensors and analysed to detect ADL. Recognised ADL were visualized using activity maps, the heterogeneity and accuracy to discriminate patients from healthy were analysed. Activity maps of dementia patients reveal unorganised behaviour patterns and heterogeneity differed significantly between the healthy and diseased. The discriminating accuracy increases with observation duration (0.95 for 20 days). Unobtrusive sensors quantify ADL-relevant behaviour, useful to uncover the effect of cognitive impairment, to quantify ADL-relevant changes in the course of dementia and to measure outcomes of anti-dementia treatments.

A Machine-to-Machine protocol benchmark for eHealth applications - Use case: Respiratory rehabilitation

BACKGROUND

M2M (Machine-to-Machine) communications represent one of the main pillars of the new paradigm of the Internet of Things (IoT), and is making possible new opportunities for the eHealth business. Nevertheless, the large number of M2M protocols currently available hinders the election of a suitable solution that satisfies the requirements that can demand eHealth applications.

OBJECTIVES

In the first place, to develop a tool that provides a benchmarking analysis in order to objectively select among the most relevant M2M protocols for eHealth solutions. In the second place, to validate the tool with a particular use case: the respiratory rehabilitation.

METHODS

A software tool, called Distributed Computing Framework (DFC), has been designed and developed to execute the benchmarking tests and facilitate the deployment in environments with a large number of machines, with independence of the protocol and performance metrics selected.

RESULTS

DDS, MQTT, CoAP, JMS, AMQP and XMPP protocols were evaluated considering different specific performance metrics, including CPU usage, memory usage, bandwidth consumption, latency and jitter. The results obtained allowed to validate a case of use: respiratory rehabilitation of chronic obstructive pulmonary disease (COPD) patients in two scenarios with different types of requirement: Home-Based and Ambulatory.

CONCLUSIONS

The results of the benchmark comparison can guide eHealth developers in the choice of M2M technologies. In this regard, the framework presented is a simple and powerful tool for the deployment of benchmark tests under specific environments and conditions.

A New Paradigm of Technology-Enabled ‘Vital Signs’ for Early Detection of Health Change for Older Adults

Environmentally embedded (nonwearable) sensor technology is in continuous use in elder housing to monitor a new set of ‘vital signs' that continuously measure the functional status of older adults, detect potential changes in health or functional status, and alert healthcare providers for early recognition and treatment of those changes. Older adult participants' respiration, pulse, and restlessness are monitored as they sleep. Gait speed, stride length, and stride time are calculated daily, and automatically assess for increasing fall risk. Activity levels are summarized and graphically displayed for easy interpretation. Falls are detected when they occur and alerts are sent immediately to healthcare providers, so time to rescue may be reduced. Automated health alerts are sent to healthcare staff, based on continuously running algorithms applied to the sensor data, days and weeks before typical signs or symptoms are detected by the person, family members, or healthcare providers. Discovering these new functional status ‘vital signs', developing automated methods for interpreting them, and alerting others when changes occur have the potential to transform chronic illness management and facilitate aging in place through the end of life. Key findings of research in progress at the University of Missouri are discussed in this viewpoint article, as well as obstacles to widespread adoption.

Literature review on monitoring technologies and their outcomes in independently living elderly people

PURPOSE

To obtain insight into what kind of monitoring technologies exist to monitor activity in-home, what the characteristics and aims of applying these technologies are, what kind of research has been conducted on their effects and what kind of outcomes are reported.

METHODS

A systematic document search was conducted within the scientific databases Pubmed, Embase, Cochrane, PsycINFO and Cinahl, complemented by Google Scholar. Documents were included in this review if they reported on monitoring technologies that detect activities of daily living (ADL) or significant events, e.g. falls, of elderly people in-home, with the aim of prolonging independent living.

RESULTS

Five main types of monitoring technologies were identified: PIR motion sensors, body-worn sensors, pressure sensors, video monitoring and sound recognition. In addition, multicomponent technologies and smart home technologies were identified. Research into the use of monitoring technologies is widespread, but in its infancy, consisting mainly of small-scale studies and including few longitudinal studies.

CONCLUSIONS

Monitoring technology is a promising field, with applications to the long-term care of elderly persons. However, monitoring technologies have to be brought to the next level, with longitudinal studies that evaluate their (cost-) effectiveness to demonstrate the potential to prolong independent living of elderly persons. [Box: see text].

Predicting targets of human reaching motions using different sensing technologies

Rapid recognition of voluntary motions is crucial in human-computer interaction, but few studies compare the predictive abilities of different sensing technologies. This paper thus compares performances of different technologies when predicting targets of human reaching motions: electroencephalography (EEG), electrooculography, camera-based eye tracking, electromyography (EMG), hand position, and the user's preferences. Supervised machine learning is used to make predictions at different points in time (before and during limb motion) with each individual sensing modality. Different modalities are then combined using an algorithm that takes into account the different times at which modalities provide useful information. Results show that EEG can make predictions before limb motion onset, but requires subject-specific training and exhibits decreased performance as the number of possible targets increases. EMG and hand position give high accuracy, but only once the motion has begun. Eye tracking is robust and exhibits high accuracy at the very onset of limb motion. Several advantages of combining different modalities are also shown, including advantages of combining measurements with contextual data. Finally, some recommendations are given for sensing modalities with regard to different criteria and applications. The information could aid human-computer interaction designers in selecting and evaluating appropriate equipment for their applications.