Smart rehabilitation for the 21st century: The Tampa Smart Home for veterans with traumatic brain injury

An automated approach to measuring child movement and location in the early childhood classroom

Children's movement is an important issue in child development and outcome in early childhood research, intervention, and practice. Digital sensor technologies offer improvements in naturalistic movement measurement and analysis. We conducted validity and feasibility testing of a real-time, indoor mapping and location system (Ubisense, Inc.) within a preschool classroom. Real-time indoor mapping has several implications with respect to efficiently and conveniently: (a) determining the activity areas where children are spending the most and least time per day (e.g., music); and (b) mapping a focal child's atypical real-time movements (e.g., lapping behavior). We calibrated the accuracy of Ubisense point-by-point location estimates (i.e., X and Y coordinates) against laser rangefinder measurements using several stationary points and atypical movement patterns as reference standards. Our results indicate that activity areas occupied and atypical movement patterns could be plotted with an accuracy of 30.48 cm (1 ft) using a Ubisense transponder tag attached to the participating child's shirt. The accuracy parallels findings of other researchers employing Ubisense to study atypical movement patterns in individuals at risk for dementia in an assisted living facility. The feasibility of Ubisense was tested in an approximately 90-min assessment of two children, one typically developing and one with Down syndrome, during natural classroom activities, and the results proved positive. Implications for employing Ubisense in early childhood classrooms as a data-based decision-making tool to support children's development and its potential integration with other wearable sensor technologies are discussed.

Movement Path Tortuosity in Free Ambulation: Relationships to Age and Brain Disease

Ambulation is defined by duration, distance traversed, number and size of directional changes, and the interval separating successive movement episodes; more complex measures of ambulation can be created by aggregating these features. This review article of published findings defines random changes in direction during movement as "movement path tortuosity" and relates tortuosity to the understanding of cognitive impairments of persons of all ages. Path tortuosity is quantified by subjecting tracking data to fractal analysis, specifically Fractal Dimension (Fractal D), which ranges from a value of 1 when the movement path is perfectly straight to a value of 2 when the movement path is random, resembling the "drunkard's walk." The review elucidates the mathematical assumptions underlying Fractal D, its use in the analysis of movements of free ranging animals, and its application to the study of cognitive impairment and the prediction of falls in older adults. We conclude Fractal D offers a reliable, valid, sensitive, and easily interpreted real-time longitudinal measure of unrestricted movement path tortuosity unaffected by mobility aid use.

Multimodal activity monitoring for home rehabilitation of geriatric fracture patients--feasibility and acceptance of sensor systems in the GAL-NATARS study

BACKGROUND

Demographic change will lead to a diminishing care workforce faced with rising numbers of older persons in need of care, suggesting meaningful use of health-enabling technologies, and home monitoring in particular, to contribute to supporting both the carers and the persons in need.

OBJECTIVES

We present and discuss the GAL-NATARS study design along with first results regarding technical feasibility of long-term home monitoring and acceptance of different sensor modalities.

METHODS

Fourteen geriatric participants with mobility-impairing fractures were recruited in three geriatric clinics. Following inpatient geriatric rehabilitation, their homes were equipped with ambient sensor components for three months. Additionally, a wearable accelerometer was employed. Technical feasibility was assessed by system and component downtimes, technology acceptance by face-to-face interviews.

RESULTS

The overall system downtime was 6%, effected by two single events, but not by software failures. Technology acceptance was rated very high by all participants at the end of the monitoring periods, and no interference with their social lives was reported.

DISCUSSION AND CONCLUSIONS

Home-monitoring technologies were well-accepted by our participants. The information content of the data still needs to be evaluated with regard to clinical outcome parameters as well as the effect on the quality of life before recommending large-scale implementations.

Movement Path Tortuosity Predicts Compliance With Therapeutic Behavioral Prompts in Patients With Traumatic Brain Injury

OBJECTIVE

Rehabilitation of patients with traumatic brain injury typically includes therapeutic prompts for keeping appointments and adhering to medication regimens. Level of cognitive impairment may significantly affect a traumatic brain injury victim's ability to benefit from text-based prompting. We tested the hypothesis that spatial disorientation as measured by movement path tortuosity during ambulation would be associated with poorer compliance with automated prompts by veterans actively being treated for traumatic brain injury.

SETTING

Clinical polytrauma center.

PARTICIPANTS

Ten (1 female) veteran patients mean age = 35.4 (SD = 12.4) years.

DESIGN

Small group correlational study without random assignment.

MAIN MEASURES

Fractal Dimension, a measure of movement path tortuosity derived from a GPS logging device used to record casual outdoor ambulation at the start of the study. Compliance with smart home machine-generated therapeutic prompts received during rehabilitation at the James A. Haley Veterans Administration Hospital Polytrauma Transitional Rehabilitation Program. A patient was compliant with a prompt if they transited from where the prompt was presented to the prescribed destination (both within the Polytrauma Transitional Rehabilitation Program) within 30 minutes. Noncompliance was failure to appear at the destination within the allotted time.

RESULTS

Fractal dimension was significantly inversely related to overall prompt compliance (r = -0.603, n = 10, P = .032; 1-tailed).

CONCLUSIONS

The findings support the hypothesis that increased spatial disorientation adversely impacts compliance with automated prompts throughout therapy. The results are consistent with previous studies linking elevated path tortuosity to cognitive impairment and increased risk for falls in assisted living facility residents.